Case Number: _________________________
(to be assigned by the Clerk’s Office)
Nevada AOC – Research & Statistics Unit Revised 03/2019
Pursuant to NRS 3.275
CLARK COUNTY, NEVADA
FAMILY COURT COVER SHEET
PARTIES:
Plaintiff/Petitioner Defendant/Respondent/Co-Petitioner/Protected Person
Last Name: Last Name:
First Name: Middle Name: First Name: Middle Name:
Mailing Address: Mailing Address:
City, State, Zip: City, State, Zip:
Phone #: Date of Birth: Phone #: Date of Birth:
Email Address: Email Address:
Attorney Information not applicable Attorney Information not applicable
Name: Bar No. Name: Bar No:
Address: Address:
City, State, Zip: City, State, Zip:
Phone #: Phone #:
CASE TYPE: (Check only one box only
for the primary type of case you are filing)
DISSOLUTION
MISC. DOMESTIC RELATIONS
PETITIONS
GUARDIANSHIP OTHER
Annulment
Divorce –No minor child(ren)
Divorce –With minor child(ren)
Foreign Decree
Joint Petition –No minor child(ren)
Joint Petition – With minor child(ren)
Separate Maintenance
Adoption –Minor
Adoption –Adult
Child Custody (non-divorce)
Child Support (private party)
Mental Health
Name Change
Paternity
Permission to Marry
Temporary Protective Order (TPO)
Termination of Parental Rights
(private party)
Termination of Parental Rights
(State initiated)
Visitation (non-divorce)
Other (identify) __________________
Guardianship of an Adult
Person
Estate
Person and Estate
Guardianship of a Minor
Person
Estate
Person and Estate
Guardianship Trust
DA Child Support
DA – UIFSA
DA – Child Support In State
DA Child Dependency
DA – Abuse/Neglect
DA – No Fault
DA – Other (identify)
__________________
Juvenile
Emancipation
CHILDREN INVOLVED IN THIS CASE (if applicable)
Last Name First Name Middle Name Date of Birth Relationship
1.
2.
3.
4.
5.
6.
7.
8.
Does this family have any other current or past case(s) in the Clark County Family Court or Juvenile Court?
YES NO
____
_____________________________ __________________________________ ________________
Your Printed Name Your Signature Date
/S/
FILING CODE: FCC
