Fillable Form 1: 2 3 4 Petitioner(s), In Proper (Civil Law Self-Help Center)

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Form 1: 2 3 4 Petitioner(s), In Proper (Civil Law Self-Help Center)

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PET
(Homeowner(s)’ name)
(Homeowner(s)’ mailing address)
(Homeowner(s)’ city, state, zip code)
(Homeowner(s)’ telephone number)
(Homeowner(s)’ e-mail address)
Petitioner(s), In Proper Person
EIGHTH JUDICIAL DISTRICT COURT
CLARK COUNTY, NEVADA
,
Petitioner(s),
vs.
,
Respondent(s).
PETITION FOR FORECLOSURE MEDIATION ASSISTANCE
Petitioner(s) (insert your name(s)) ____________________________ (hereafter “Petitioner(s)”),
hereby petition(s) this Court, pursuant to the terms of Chapter 107 of the Nevada Revised
Statutes, to grant participation in the mediation program for homeowners facing foreclosure.
Petitioner(s) state(s) as follows:
1. Residence. The home that is under foreclosure proceedings is in the county of (insert county
where property is located) _________________ in the State of Nevada. Petitioner(s) is/are the
occupant(s) and owner(s) of this home.
2. APN. The Assessor’s Parcel Number (APN) of the Property is (insert APN):
__ __ __-__ __-__ __ __-__ __ __
3. Notice of Default. The Notice of Default is attached to this petition. The Notice of
Default was received within the last thirty (30) days.
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4. Mediation Fee. The required $250.00 mediation fee is submitted herewith.
Petitioner(s) hereby request(s) that this Court allow participation in the foreclosure
mediation assistance program.
DATED this day of , 20 .
Submitted by:
(Homeowner One’s signature)
(Homeowner One’s name)
Petitioner, In Proper Person
DATED this day of , 20 .
Submitted by:
(Homeowner Two’s signature)
(Homeowner Two’s name)
Petitioner, In Proper Person
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VERIFICATION IN SUPPORT OF
PETITION FOR FORECLOSURE MEDIATION ASSISTANCE
(Homeowner One)
STATE OF NEVADA )
)ss
COUNTY OF CLARK )
(Homeowner One’s name)________________________, being first duly sworn, declares under
penalty of perjury under the law of the State of Nevada that the foregoing and following is true
and correct:
I am the Petitioner in the above-entitled action. I have read the foregoing Petition for
Foreclosure Mediation Assistance, and know the contents thereof. The Petition is true of my
own knowledge except as to those matters that are stated on information and belief, and as to
those matters, I believe them to be true.
DATED THIS _____ day of _______________, 20___.
_____________________________
(Homeowner One’s signature)
_____________________________
(Homeowner One’s name)
SUBSCRIBED AND SWORN to before me this
___ day of ________, 20___.
________________________________________
NOTARY PUBLIC in and for the
County of ________, State of __________
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VERIFICATION IN SUPPORT OF
PETITION FOR FORECLOSURE MEDIATION ASSISTANCE
(Homeowner Two)
STATE OF NEVADA )
)ss
COUNTY OF CLARK )
(Homeowner Two’s name)________________________, being first duly sworn, declares under
penalty of perjury under the law of the State of Nevada that the foregoing and following is true
and correct:
I am the Petitioner in the above-entitled action. I have read the foregoing Petition for
Foreclosure Mediation Assistance, and know the contents thereof. The Petition is true of my
own knowledge except as to those matters that are stated on information and belief, and as to
those matters, I believe them to be true.
DATED THIS _____ day of _______________, 20___.
_____________________________
(Homeowner Two’s signature)
_____________________________
(Homeowner Two’s name)
SUBSCRIBED AND SWORN to before me this
___ day of ________, 20___.
________________________________________
NOTARY PUBLIC in and for the
County of ________, State of __________
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CERTIFICATE OF MAILING
I hereby certify that on this ______ day of ____________________, 20____, I served the
foregoing Petition for Foreclosure Mediation Assistance via certified mail, return receipt
requested, to the following:
TRUSTEE: (Insert name and address of trustee)
BENEFICIARY: (Insert name and address of beneficiary of the deed)
Home Means Nevada
3300 W. Sahara Ave.
Las Vegas, NV 89102
OTHER PARTY OF INTEREST: (Insert name and address of any other interested party)
DATED this _________day of ____________________, 20___
_____________________________________
Signature of Person Mailing Document
______________________________________
Printed Name
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Form 1: 2 3 4 Petitioner(s), In Proper (Civil Law Self-Help Center)

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Completed 8 January 2021

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