FOR RECORDING
STAMP
DO NOT WRITE IN
THIS AREA
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DECLARATION OF REMOVAL OF DISCRIMINATORY
RESTRICTION
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Assessor’s Parcel Number (APN):
Recording Requested by and Mail to:
Name:
Address:
City/State/Zip:
Name on Title of Property:
Mailing address:
Legal Description of the real property as provided in the original written instrument:
Identifying information concerning the original written instrument for exclusion pursuant to
NRS 111.237 Including document and/or book and page number.
(1) The referenced original written instrument contains discriminatory restrictions
that are void and unenforceable pursuant to NRS 111.237. This declaration removes
from the referenced original instrument all provisions that are void and
unenforceable pursuant to NRS 111.237 and is valid solely for that purpose; and
(2) All persons in this State shall have an equal opportunity to inherit, purchase,
lease, rent, sell, hold and convey real property without discrimination, distinction
or restriction because of race, color, religion, ancestry, national origin, disability,
familial status, sex, sexual orientation or gender identity or expression pursuant to
chapter 118 of NRS.
In witness, Whereof, I/we have hereunto set my hand/our hands this day of , 20
Signature Signature
Print o
r type name here Print or type name here
STATE OF NEVADA, COUNTY OF This instrument was acknowledged
before me on
(date)
By
Person(s) appearing before notary
By
Person(s) appearing before notary
Signature of notarial officer
Notary Seal
CONSULT AN ATTORNEY IF YOU DOUBT THIS FORM FITS YOUR PURPOSE. FORM
655 –
8/16/19
