STATE OF NEVADA
DEPARTMENT OF BUSINESS AND INDUSTRY - REAL ESTATE DIVISION
OFFICE OF THE OMBUDSMAN FOR COMMON-INTEREST COMMUNITIES AND CONDOMINIUM HOTELS
3300 W. Sahara Ave., Ste. 325 * Las Vegas, NV 89102
(702) 486-4480 * Toll free: (877) 829-9907 * Fax: (702) 486-4520
E-mail: CICOmbudsman@red.nv.gov http://red.nv.gov/
Declaration of Certification
Common-Interest Community Executive Board Member
I
(Print name clearly)
, as an elected or appointed member of the executive board
of
(Legal name of the association as it appears on Secretary of State’s website)
, a common-interest
community or condominium hotel, Secretary of State (SOS) Entity Number of ,
certify that I have read and understand, the governing documents of the association and the provisions of
Chapter 116 or 116B of Nevada Revised Statutes (NRS) and Chapter 116 of the Nevada Administrative Code
(NAC) to the best of my ability.
Indicate the following one of the following:
Elected to the board on .........................................................................................
..................................................................................
...................................................................................
Re-Elected to the Board on
Appointed to the Board on
Position elected, re-elected, or appointed to: President Vice President Secretary Treasurer Director
“I declare under penalty of perjury under the law of the State of Nevada that the foregoing is
true and correct.”
Signature Date
The Office of the Ombudsman for Common-Interest Communities and Condominium Hotels
offers board member training free of charge. For more information, contact our office or visit our
training webpage at http://red.nv.gov/Content/CIC/Program_Training/.
Pursuant to NRS 116.31034(19) “Each member of the executive board shall, within 90 days after his or her appointment or election,
certify in writing to the association, on a form prescribed by the Administrator, that the member has read and understands the governing
documents of the association and the provisions of this chapter to the best of his or her ability. The Administrator may require the
association to submit a copy of the certification of each member of the executive board of that association at the time the association
registers with the Ombudsman pursuant to NRS 116.31158.”
Do not submit this form to the Division.
This form is required to be kept as an association record that MAY be requested by the
Division at any time.
Revised 9/9/19 Form 602
