Department of Social Service
1600 Pinto Lane • Las Vegas NV 89106
(702) 455-4270 • Fax (702) 455-5950
Examp
le 2. COVID-19 Confirmation
Today’s Date:
Landlord’s Name:
Primary Lease Holder’s Name:
The Landlord named above has confirmed with the Primary Lease Holder named above that
difficulty making rent payments is the result of loss of income due to COVID-19. Reason(s)
include (check all that apply):
o Laid off
o Place of employment has closed
o Loss of work hours
o Must stay home to care for children due to closure of day care and/or school
o Reduction or elimination of child or spousal support
o Not able to work and/or missed hours due to contracting COVID-19
o Unable to find work due to COVDI-19
o Unwilling or unable to participate in their previous employment due to their high risk of
severe illness from COVID-19
o Other:
