Fillable Form 1: PSWA 2 3 (Civil Law Self-Help Center)

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Form 1: PSWA 2 3 (Civil Law Self-Help Center)

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PSWA
_____________________________
(Name)
_____________________________
(Address)
_____________________________
(City, State, Zip Code)
_____________________________
(Telephone number/Fax Number)
_____________________________
(E-Mail address)
Petitioner, Self-Represented
EIGHTH JUDICIAL DISTRICT COURT
CLARK COUNTY, NEVADA
In the Matter of the Estate of:
_______________________________________,
Deceased.
Case No.: P ________________
Dept. No.: PC-1
PETITION TO SET ASIDE
ESTATE WITHOUT ADMINISTRATION
Petitioner,
(your name) ______________________________________________, appearing
self-represented, hereby petitions the Court for an Order setting aside the estate of (name of person who
passed away)
_____________________________, Deceased, without administration pursuant to
NRS 146.070. In support of this Petition, Petitioner respectfully states the following:
1. Petitioner is the (your relation to the decedent) ___________________ of Decedent and resides
at (your address) _____________________________________________________________. A
copy of Petitioner’s identification is attached hereto as Exhibit A.
2. Decedent died on the (day, month, and year of death) ____________________________, in
(county where the decedent died)_________________________ and, on the date of death, Decedent was a
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resident of (city and state where the decedent lived at time of death)_________________________. A certified
copy of Decedent’s death certificate is attached herein as Exhibit B.
3. Jurisdiction is proper in this proceeding.
4. There is no record of a Last Will and Testament and, therefore, Petitioner believes
the Decedent died intestate.
5. The Decedent left an estate in Clark County, Nevada, consisting of the following
separate property:
(List all the property in decedent’s estate, and be specific.
• For bank accounts, CDs, stock certificates, etc., include the name of the financial institution & account number.
• For vehicles, include year, make, model, & vehicle identification number (VIN).
• List all personal property, including furniture, jewelry, cash, etc.
• For real property (houses, land, etc.), include property street address, legal description, & assessor’s parcel number (APN).
The “Estimated Gross Value” is the value of the property, before deductions. For example, it is the value of a house or a car without subtracting
any liens or mortgages.)
Type of Property & Description
Estimated Gross Value
The estimated values of the above assets were determined by the proofs of value attached as
Exhibit C.
6. The gross value of the estate is (add up the numbers in the “Estimated Gross Value” column)
$_______________.
/ / /
/ / /
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7. At the date of Decedent’s death, there were liens and mortgages on the above property
as follows:
(List all secured debt—debt where if payments are not made, the lender or lienholder can take the property back. The most common lienholders
are mortgage companies and car loan finance companies. Under the “Lienholder” column, list the names of the entities holding the liens or
mortgages; under “Estimated Amount Owed,” list the estimated amount owed to each lienholder. Also include any liens and encumbrances that
you might believe are unenforceable, and explain why you believe this.)
Lienholder
Proof of the above liens and mortgages is attached as Exhibit D.
8. The estimated value of Decedent’s property is
(take the total “Estimated Gross Value” that you listed in
#5 and subtract the estimated amounts owed above)
$___________________.
9. At the date of Decedent’s death, Decedent owed the following unsecured debts:
(List all unsecured debt—a debt that is not backed by some kind of asset or collateral. This generally includes credit card bills and medical bills.
Under “Unsecured Creditor,” list the name of the entity to whom the debt is owed, and under “Estimated Amount Owed,” list the estimated
amount owed.)
Unsecured Creditor
Proof of the above unsecured debts is attached as Exhibit E.
/ / /
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10. The names, relationships, ages of minors, and residence addresses of all the
devisees, legatees, heirs, and next-of-kin of Decedent, so far as known to Petitioner, are:
(You must include the name, relationship, age (if under 18) and address of (1) decedent’s legally married spouse, (2) all decedent’s children; (3)
all other devisees, legatees, heirs, and next-of kin. List all persons, regardless of age, even if estranged or out of state. Include all addresses; if
unknown, include last known address or state “unknown.” Your information will go in the first set of boxes.)
Name
Relationship to
Decedent
Age
(if under 18, list age; if over 18,
write “adult.”)
Address
Your name here.
Your relationship to decedent.
Your age.
Your address.
Check here if you have more people to include, and attach a continuation sheet.
11. The devisees, legatees, heirs, and next-of-kin of Decedent who are listed above
will be noticed of the instant Petition; otherwise, an Affidavit in Support of Petition to Set Aside
explaining their whereabouts is herein attached as Exhibit F.
12. The gross value of the Estate of Decedent, after deducting encumbrances, does
not exceed $100,000.00, and therefore the estate may be set aside in its entirety pursuant to NRS
146.070(1) or pursuant to the laws of intestate succession and NRS 134.
WHEREFORE, the Petitioner prays:
1. That the gross value of the Estate of Decedent, after deducting any encumbrances,
does not exceed $100,000.00.
/ / /
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2. That the Decedent’s estate be set aside in the following manner pursuant to NRS
146.070(1) or pursuant to the laws of intestate succession and NRS 134:
(List all the people who you are asking to receive property, and in what percentage they’ll receive property, or what they will be receiving. For
example, if you are asking that everything goes to you, you might say, “The entirety of the estate to John Doe.” Or if you want to split the estate
between you and two others, you might say, “50% of the estate to John Doe and 50% of the estate to Bob Brown.” Or, if you can be more specific
as to items, you might say, “The Chase Checking Account #123456 to John Doe; the 2014 Toyota Camry, VIN 123456, to Bob Brown; and the
gold ring to Jane Doe.”)
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
_____________________________________________________________________________.
3. For all other necessary and proper orders.
DATED THIS _____ day of _______________, 20___.
Respectfully submitted,
_____________________________
(signature)
_____________________________
(Your name)
_____________________________
(Your address)
_____________________________
(Your city, state, and zip)
_____________________________
(Your phone number)
_____________________________
(Your email)
PETITIONER, SELF-REPRESENTED
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VERIFICATION IN SUPPORT OF PETITION TO SET ASIDE WITHOUT
ADMINISTRATION
STATE OF NEVADA )
)ss
COUNTY OF CLARK )
(Your 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 to Set
Aside without Administration, and that the same is true of my own knowledge, except for
matters stated therein on information and belief, and as for those matters, I believe them to be
true.
DATED THIS _____ day of _______________, 20___.
_____________________________
(Signature)
_____________________________
(Your name)
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NOHE
_____________________________
(Name)
_____________________________
(Address)
_____________________________
(City, State, Zip Code)
_____________________________
(Telephone number/Fax Number)
_____________________________
(E-Mail address)
Petitioner, Self-Represented
EIGHTH JUDICIAL DISTRICT COURT
CLARK COUNTY, NEVADA
In the Matter of the Estate of:
_______________________________________,
Deceased.
Case No.: P
Dept. No.: PC-1
NOTICE OF HEARING RE: PETITION TO SET ASIDE
ESTATE WITHOUT ADMINISTRATION
PLEASE TAKE NOTICE that Petitioner, (your name) __________________________,
filed with the Court a Petition Set Aside the Estate to (your name and names of any persons who will receive estate if
your petition is granted)
______________________________________________________________________________
______________________________________________________________________________
without Administration in the matter of the above-named Decedent; that a hearing on the Petition
has been set for the ____ day of ___________, 20_____ , at the hour of 9:30 a.m., in the Probate
Court, which is located at the Regional Justice Center at 200 Lewis Avenue, Las Vegas, NV
89155.
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Further details concerning this Petition can be obtained by reviewing the Court file at the
Office of the Clerk of Court at 200 Lewis Avenue in Las Vegas, Nevada, or by contacting the
Petitioner(s) whose name, address, and telephone number is:
(your name) __________________________________________________
(your address) __________________________________________________
(your city, state, zip) __________________________________________________
(your phone number) __________________________________________________
DATED this ____ day of ___________, 20_____.
_____________________________
(Signature)
_____________________________
(Your name)
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CERT
_____________________________
(Name)
_____________________________
(Address)
_____________________________
(City, State, Zip Code)
_____________________________
(Telephone number/Fax Number)
_____________________________
(E-Mail address)
Petitioner, Self-Represented
EIGHTH JUDICIAL DISTRICT COURT
CLARK COUNTY, NEVADA
In the Matter of the Estate of:
_______________________________________,
Deceased.
Case No.: P
Dept. No.: PC-1
CERTIFICATE OF MAILING
I HEREBY CERTIFY that service of the Notice of Hearing re: Petition Set Aside the
Estate Without Administration was made this
(day of mailing) ____ day of (month of mailing)
___________________, 20(year of mailing) _____, by depositing a copy of the same in the U.S.
Mail, postage prepaid, regular mail, addressed to: (You are required by statute to mail a Notice of
Hearing to Medicaid Estate Recovery, regardless of whether Decedent received Medicaid or not, or owed to
Medicaid or not. You are also required to mail a Notice of Hearing to all beneficiaries, heirs, and creditors.)
1. State of Nevada Dept. of Health and Human Services, Medicaid Estate Recovery,
1100 East William Street, #109, Carson City, NV 89701
(Include below the names and addresses of every entity and/or person you listed in Question #7, 9, & 10 of your Petition.)
2. __________________________________________________________________
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3. __________________________________________________________________
4. __________________________________________________________________
5. __________________________________________________________________
6. __________________________________________________________________
7. __________________________________________________________________
8. __________________________________________________________________
9. __________________________________________________________________
10. __________________________________________________________________
DATED THIS _____ day of _______________, 20___.
_____________________________
(Signature)
_____________________________
(Your name)
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OSEA
_____________________________
(Name)
_____________________________
(Address)
_____________________________
(City, State, Zip Code)
_____________________________
(Telephone number/Fax Number)
_____________________________
(E-Mail address)
Petitioner, Self-Represented
EIGHTH JUDICIAL DISTRICT COURT
CLARK COUNTY, NEVADA
In the Matter of the Estate of:
_______________________________________,
Deceased.
Case No.: P
Dept. No.: PC-1
ORDER TO SET ASIDE ESTATE WITHOUT ADMINISTRATION
It appearing to the satisfaction of the Court that a Petition to Set Aside the Estate Without
Administration of the above named Decedent has been filed, and that notice of the time and
place of the hearing thereon has been duly given in the manner prescribed by law, and that no
one has objected or presented any reason why said Petition should not be granted.
The Court finds that the gross value of the Nevada Estate of the Decedent, after deducting
any encumbrances, does not exceed One Hundred Thousand Dollars ($100,000.00), and this is a
proper case for the whole of the Estate to be set aside, pursuant to NRS 146.070(1) or pursuant to
the laws of intestate succession and NRS 134.
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IT IS HEREBY ORDERED, ADJUDICATED AND DECREED:
1. That the Nevada Estate of (decedent’s name) __________________________________,
Decedent, is hereby found to include:
(List, with specificity, all the property in decedent’s estate.
• For bank accounts, CDs, stock certificates, etc., include the name of the financial institution & account number.
• For vehicles, include year, make, model, & vehicle identification number (VIN).
• List all personal property, including furniture, jewelry, cash, etc.
• For real property (houses, land, etc.), include property street address, legal description, & assessor’s parcel number (APN).
• The “Estimated Gross Value” is the value of the property, before deductions. For example, it is the value of a house or a car without
subtracting any liens or mortgages.)
Type of Property & Description
Estimated Gross Value
2. That this Order shall be used as the document transferring the title to said
property; and that Decedent’s Estate is hereby transferred, assigned and set aside in the following
manner:
(List all the people who will receive property, and in what percentage they’ll receive property, or what they will be receiving. For example, if
everything goes to you, you might say, “The entirety of the estate to John Doe.” Or if you want to split the estate between you and two others, you
might say, “50% of the estate to John Doe and 50% of the estate to Bob Brown.” Or, if you can be more specific as to items, you might say, “The
Chase Checking Account #123456 to John Doe; the 2014 Toyota Camry, VIN 123456, to Bob Brown; and the gold ring to Jane Doe.”)
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
_____________________________________________________________________________.
/ / /
/ / /
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4. That said Estate shall not be further administered upon.
DATED this ____ day of ___________, 20_____.
_______________________________
DISTRICT COURT JUDGE
Respectfully submitted,
By: ___________________
(signature)
___________________
(print name)
SELF-REPRESENTED
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EXHIBIT A
(Petitioner’s Identification)
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EXHIBIT B
(Death Certificate)
MAKE SURE YOU HAVE REDACTED THE DECEDENT’S SOCIAL SECURITY NUMBER!!!
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EXHIBIT C
(Proof of Value of Assets)
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EXHIBIT D
(Proof of Value of Liens & Mortgages)
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EXHIBIT E
(Proof of Unsecured Debts)
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EXHIBIT F
(Affidavit in Support of Petition)
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Form 1: PSWA 2 3 (Civil Law Self-Help Center)

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Completed 8 January 2021

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