Fillable Form 1: 2 3 4 5 G Plaintiff/ (Civil Law Self-Help Center)

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Form 1: 2 3 4 5 G Plaintiff/ (Civil Law Self-Help Center)

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©
Civil Law Self-Help Center
Clark County, Nevada
(Name)
(Address)
(City, State, Zip)
(Telephone)
G Plaintiff/ G Defendant, Pro Se
JUSTICE COURT,
CLARK COUNTY, NEVADA
)
, ) Case No.:
) Dept. No.:
Plaintiff(s), )
)
vs. )
)
)
, )
) Date of Hearing: N/A
Defendant(s). ) Time of Hearing: N/A
)
Pursuant to JCRCP 74(c), Appellant hereby submits a
statement of the evidence or proceedings before the lower Court as follows (briefly state what
happened at your hearing, particularly those issues that relate to your appeal)
:
STATEMENT OF EVIDENCE OR PROCEEDINGS
__________________________ TOWNSHIP
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©
Civil Law Self-Help Center
Clark County, Nevada
DATED this day of , 20 .
Pursuant to NRS 53.045, I declare under penalty of
perjury that the foregoing is true and correct.
(signature)
(print name)
G Plaintiff/ G Defendant, Pro Se
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©
Civil Law Self-Help Center
Clark County, Nevada
CERTIFICATE OF MAILING
I HEREBY CERTIFY that service of the foregoing STATEMENT OF EVIDENCE OR
PROCEEDINGS was made on (insert date) ____________________________, 20_____,
pursuant to JCRCP 5(b), by depositing a copy of the same in the United States Mail in Las
Vegas, Nevada, postage prepaid, addressed as follows (insert name and address of the opposing
party’s attorney, or opposing party if unrepresented):
Per NRS 53.045, “I declare under penalty of perjury that the foregoing is true and
correct.”
(Date) (Type or print name) (Signature)
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Form 1: 2 3 4 5 G Plaintiff (Civil Law Self-Help Center)

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Completed 8 January 2021

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