Fill - PREPARING A PRE-TRIAL MEMORANDUM

June 13, 2001 Use only most current version

PREPARING A PRE-TRIAL MEMORANDUM

EXPLANATION OF A PRE-TRIAL MEMORANDUM

A Pre-Trial Memorandum is the primary document the judge uses to

prepare for your trial. It summarizes all of your legal and

factual arguments. It also states whom you will have testify on

your behalf and what you expect those witnesses to say.

YOU CAN USE THIS PACKAGE FOR PREPARING A PRE-TRIAL MEMORANDUM IF:

#

You have received notification from your judge’s

department that you need to file a Pre-Trial

Memorandum; or

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You have a trial scheduled in the near future and have

not filed a Pre-Trial Memorandum.

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INSTRUCTIONS FOR PREPARING A PRE-TRIAL MEMORANDUM

* * * IMPORTANT DISCLOSURE * * *

THIS INFORMATION IS PROVIDED AS A COURTESY

ONLY. CLARK COUNTY, THE EIGHTH JUDICIAL

DISTRICT COURT, THE SELF-HELP CENTER AND THEIR

EMPLOYEES SHALL NOT BE LIABLE FOR ERRORS

CONTAINED HEREIN OR FOR DIRECT, INDIRECT,

SPECIAL OR CONSEQUENTIAL DAMAGES IN CONNECTION

WITH THE FURNISHING OF THIS MATERIAL.

MANY FAMILY LAW MATTERS INVOLVE COMPLEX AND

VALUABLE LEGAL RIGHTS. THESE FORMS AND

INSTRUCTIONS ARE BASIC, GENERAL FORMS, AND MAY

NOT FIT ALL SITUATIONS. SOME RIGHTS CANNOT BE

ADEQUATELY PROTECTED WITHOUT THE ASSISTANCE OF

AN ATTORNEY. YOU SHOULD CONSULT WITH AN

ATTORNEY BEFORE YOU ATTEMPT TO USE SELF-HELP.

* * * * *

I. EXPLANATION OF A PRE-TRIAL MEMORANDUM

A. A Pre-Trial Memorandum is the primary document the

judge uses to prepare for your trial. It summarizes

all of your legal and factual arguments. It also

states whom you will have testify on your behalf and

what you expect those witnesses to say.

B. You can use this package for preparing a Pre-Trial

Memorandum if:

 You have received notification from your

judge’s department that you need to file a

Pre-Trial Memorandum; or

 You have a trial scheduled in the near

future and have not filed a Pre-Trial

Memorandum.

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C. This package should contain the following documents:

 Instructions for Preparing a Pre-Trial

Memorandum;

 Pre-Trial Memorandum;

 Affidavit of Financial Condition;

 Certificate of Mailing;

 List of telephone numbers for the judges’

staffs and the Court Clerks;

 Customer survey;

 Affirmation.

II. STEP 1: PREPARE YOUR PAPERWORK

NOTE: WHEN FILLING OUT ANY FORM, YOU MUST USE BLACK INK.

PRINT CLEARLY. THE CLERK’S OFFICE WILL NOT FILE YOUR

DOCUMENT IF THE HANDWRITING IS HARD TO READ.

A. THE CAPTION:

The “caption” is the portion of your document which

assists the Court in identifying your particular case.

It is the part of the page that has the word

“Plaintiff” under a line and the word “Defendant” under

another line. Generally, this caption will remain the

same throughout the entire case and will be on every

document filed in this action. In this package, the

caption is on the: (1) Pre-Trial Memorandum, (2)

Affidavit of Financial Condition, (3) Certificate of

Mailing, and (4) Affirmation.

B. THE PRE-TRIAL MEMORANDUM:

1. The Pre-Trial Memorandum is the primary document

that the judge uses to prepare for your trial.

It summarizes all of the legal and factual

arguments and also lists all of the witnesses

that you plan to have testify on your behalf.

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2. Insert your name, address, and phone number on

the first page, upper left-hand corner.

3. Insert the name of the Plaintiff on the blank

above the word “Plaintiff” in the caption and

insert the name of the Defendant on the blank

above the word “Defendant” in the caption. You

can determine who is the Plaintiff and who is the

Defendant by looking at other documents that have

been filed in your case.

4. Insert the case number on the line after the

words “CASE NO.” and insert the department letter

on the line after the words “DEPT. NO.” You can

determine the case number and department letter

by looking at other documents that have been

filed in your case.

5. Check either “Plaintiff” or “Defendant” in the

title of the document.

6. The Pre-Trial Memorandum uses a fill-in-the-blank

format and will tell you what information you

need to put into the blank.

a. If a section does not apply, write “N/A” on

the first blank line in that section.

b. For Section VII, do not list yourself, the

other party, or a person who is going to

testify only to the Plaintiff’s Nevada

residency.

c. The Pre-Trial Memorandum has two exhibits.

In “Exhibit A,” list the assets and debts of

both

parties and state how you would like

the judge to divide those assets and debts.

A sample is on the last page of these

instructions. “Exhibit B” will be your most

current Affidavit of Financial Condition.

(Please see section “C,” below.) You do not

need to attach an Affidavit of Financial

Condition if you do not have children and

neither party is requesting spousal support.

C. THE AFFIDAVIT OF FINANCIAL CONDITION:

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NOTE: YOU DO NOT NEED TO COMPLETE THIS FORM IF: (1)

YOU HAVE ALREADY FILED AN AFFIDAVIT OF FINANCIAL

CONDITION AND

YOUR FINANCIAL CIRCUMSTANCES HAVE NOT

CHANGED SINCE THAT TIME; OR (2) YOU AND THE OTHER

PARTY DO NOT HAVE CHILDREN TOGETHER AND NEITHER PARTY

WANTS SPOUSAL SUPPORT.

1. The Affidavit of Financial Condition (also known

as an “AFC”) is the document used by the judge to

review your income, expenses, assets and debts.

It will also help the judge determine how much

child support and/or spousal support should be

awarded. There are instructions on the first two

pages of the AFC. Please follow those

instructions.

a. If you have already filed an AFC and are

filing this one to update information, write

the word “Amended” before the words

“Domestic Relations Affidavit of Financial

Condition” on the first page of the

document.

2. Usually, the AFC will be on paper that makes

copies when you write on it. You will need to

print very hard

to make sure that your writing

comes through on all of the copies.

D. THE CERTIFICATE OF MAILING:

NOTE: PART OF THIS DOCUMENT WILL HAVE TO BE COMPLETED

BY SOMEONE ELSE. (PLEASE SEE THIS SECTION AND SECTION

V, BELOW.)

1. The Certificate of Mailing is a document to show

the court that the other party received a copy of

the papers you have just filed. Someone who you

are not related to you by blood or marriage and

who is over 18 years old, will need to complete

part of this document. This other person is

called a “third party”. (Please see Section V,

below, for more information.)

2. Insert your name, address, and phone number on

the first page, upper left-hand corner.

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3. Insert the name of the Plaintiff on the blank

above the word “Plaintiff” in the caption and

insert the name of the Defendant on the blank

above the word “Defendant” in the caption.

4. Insert the case number on the line after the

words “CASE NO.” on your documents and insert the

department letter on the line after the words

“DEPT. NO.”

5. The Certificate of Mailing uses a fill-in-the-

blank format and will tell you what information

you need to put into the blank.

a. The third party will need to fill in the

date that he/she mailed the documents to the

other side and sign the Certificate of

Mailing.

E. THE AFFIRMATION:

NOTE: You will need to file an Affirmation each time

you file documents. You may want to make a few copies

of the form before completing it.

1. Beginning January 1, 2007, most documents should

not contain parties’ Social Security Numbers.

If certain documents are required to have this

information, the Clerk’s Office and/or the Court

must take steps to ensure that the information

is kept in a confidential manner. The

Affirmation lets the Clerk’s Office and the

Court know whether the documents you file

contain Social Security Numbers.

2. Insert your name, address, and phone number on

the first page, upper left-hand corner. The

form uses a “fill-in-the-blank” format. Write

the information requested on each line in the

caption.

3. If you or the other party has already filed

paperwork, fill in the “Case No.” and “Dept.

No.” lines to the right of the caption. You can

find this information by looking at other

documents that have been filed in the in the

case, leave the lines blank. The Clerk’s Office

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will give you a case number and department

number when you file the paperwork.

4. Check the boxes next to the documents you are

filing. If you are filing document that is not

listed, check the “other” box and state the name

of the document on the line next to the box.

5. Sign and date the form.

III. STEP 2: FILE THE PRE-TRIAL MEMORANDUM AND AFFIDAVIT OF

FINANCIAL CONDITION (IF USED)

A. Make three copies of the Pre-Trial Memorandum

(including the exhibits) and one copy of the

Affirmation.

B. If you completed the AFC and it was not on paper that

made carbon copies, you will need to make two copies.

C. You need to use a two-hole punch on the top of the

original documents and also stamp or write "Original"

on the original documents. The Self-Help Center has a

two-hole punch and a stamp that you can use.

D. Go to the filing counter at the Clerk's Office. The

Clerk will file the original documents and will return

the copies to you. These are called “file-stamped

copies.”

IV. STEP 3: GIVE THE JUDGE A “COURTESY COPY” OF THE PRE-TRIAL

MEMORANDUM AND AFFIDAVIT OF FINANCIAL CONDITION (IF USED)

A. When a trial or calendar call is scheduled very close

to the date that the Pre-Trial Memorandum is due, the

Clerk’s Office may not have time to get the document

into the court file before the judge wants to prepare

for the hearing. Therefore, it is very important

that

you give the judge a copy of your paperwork as quickly

as possible. The copies that you give to the judge are

called “courtesy copies”.

1. Please be sure that the case number and department

letter are on all of the documents that you give

to the judge to review.

B. Take the elevator to the third floor of the courthouse.

Go to the reception area by "chambers”. You will see

brown boxes against the wall. Each box is marked with

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a department letter. Put a file-stamped copy of the

Pre-Trial Memorandum and the AFC (if used) into the box

belonging to that department.

V. STEP 4: SERVE THE OTHER PARTY AND FILE THE CERTIFICATE OF

MAILING

A. As a general rule, you must give the other party a

copy of the anything that you file with the Court.

If that party is represented by an attorney, you must

give the documents to the attorney instead of the other

party. The way of giving the documents to the other

party (or the attorney) is called “service of process”

or “service”. For this packet, you must serve the: (1)

Pre-Trial Memorandum, and (2) Affidavit of Financial

Condition (if used).

1. Any document that is “served” must be mailed or

delivered by someone who is not related to you by

blood or marriage and who is over 18 years old.

This person is called a “third party”.

B. There are several ways of serving the other party.

However, this packet contains a Certificate of

Mailing. This is the most common method of serving a

Pre-Trial Memorandum and an AFC. To learn more about

other methods of service, you can review the Nevada

Rules of Civil Procedure at the Self-Help Center, any

Clark County public library, or on-line at

http://www.leg.state.nv.us/law1.htm You may also speak

to an attorney.

1. If the other party does not have an attorney

, the

third party should mail the documents to the

other side’s last known address (the address you

put in the Certificate of Mailing).

2. If the other party has an attorney

, the third

party can mail the document to the attorney at

the attorney’s business address.

C. After the third party has mailed the Pre-Trial

Memorandum and the AFC (if used) to the other side (or

that side’s attorney), he/she should complete their

portion of the Certificate of Mailing. You will need

to prepare an Affirmation.

1. Make one copy of the Certificate of Mailing and

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one copy of the Affirmation.

2. You need to use a two-hole punch on top of the

original documents and also stamp or write

“Original” on the original documents. The Self-

Help Center has a two-hole punch and a stamp that

you can use.

3. Go to the filing counter at the Clerk’s Office.

The Clerk will file the original documents and

will return the file-stamped copies to you. Keep

this copy for your records.

VI. STEP 5: WHAT HAPPENS NEXT

What happens next depends on the department that your case

has been assigned to. You should have already received

notification of either a trial date or a calendar call

date. If you received a calendar call date, the trial date

should be given to you during the calendar call. If you do

not know either the calendar call date or the trial date,

you may want to call the Judicial Executive Assistant for

that department or the Self-Help Center. You can also

find hearing dates on the Clerk’s Office’s Web site:

http://www.co.clark.nv.us/clerk/clerkhome.htm

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SAMPLE ASSET SCHEDULE

ASSET Your opinion

regarding

value

(gross)

Manner in

which title

is held

Name of

Creditor

with secured

obligation

on asset &

loan amount

PROPOSED

DISTRIBUTION

Home

1000 4

th

St.

Las Vegas,

NV

$100,000 Joint

Tenancy

AAA Mortgage

Co. $45,000

Sell and

divide

proceeds

SAMPLE DEBT SCHEDULE

CREDITOR AMOUNT OWED

Assets

securing

obligation

PROPOSED RESOLUTION

AAA Mortgage

Co., Inc.

$45,000

First Trust

Deed on home

at 1000 4

th

St. Las

Vegas, NV

Debt paid from proceeds of

sale

1

st

USA Visa $1,000 None Defendant to pay

These forms can be filled out online.

To begin, left click on the first line.

In order to move to the next line hit

the "tab" key.

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PMEM

(Your name) __________________________

(Address) __________________________

__________________________

(Telephone) __________________________

In Proper Person

DISTRICT COURT

CLARK COUNTY, NEVADA

)

_______________________, ) CASE NO.: ____________

)

Plaintiff, ) DEPT. NO.: ____________

vs. )

)

_______________________, )

)

Defendant. )

______________________________)

G PLAINTIFF’S/ G DEFENDANT’S PRE-TRIAL MEMORANDUM

I.

STATEMENT OF ESSENTIAL FACTS

A. Name of Plaintiff: ________________________________________, age ____________

B. Name of Defendant: ______________________________________, age ____________

C. Date of Marriage: _______________________________

D. Resolved issues and the agreements:

1. ____________________________________________________________________

____________________________________________________________________

2. ____________________________________________________________________

____________________________________________________________________

3. ____________________________________________________________________

____________________________________________________________________

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E. Unresolved issues:

1. ____________________________________________________________________

____________________________________________________________________

2. ____________________________________________________________________

____________________________________________________________________

3. ____________________________________________________________________

____________________________________________________________________

II.

CHILD CUSTODY

A. Name, age and date of birth of children:

Name: __________________________________, age _____, date of birth: ___________

B. Requested custody and visitation order:

________________________________________________________________________

III.

CHILD SUPPORT

A. Amount of child support requested and any special factors which the Court should consider

in setting the amount of child support: _________________________________

_______________________________________________________________________

IV.

SPOUSAL SUPPORT

A. (CHECK ONLY ONE BOX)

G (Check one) G Plaintiff/ G Defendant does not request spousal support.

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OR

G (Check one) G Plaintiff/ G Defendant requests permanent spousal support in the amount

of $______________ per month.

OR

G (Check one) G Plaintiff/ G Defendant requests rehabilitative spousal support in the

amount of $____________ per month for ______________ (check one) G months/ G years

B. (CHECK ONLY ONE BOX)

G (Check one) G Plaintiff’s/ G Defendant’s request for spousal support should be granted

because ____________________________________________________________________

___________________________________________________________________________

OR

G (Check one) G Plaintiff’s/ G Defendant’s request for spousal support should be denied

because ___________________________________________________________________

__________________________________________________________________________

V.

PROPERTY AND DEBTS

A. (Check one that applies to you) G Plaintiff’s/ G Defendant’s proposed distribution of

property and debts is attached to this Pre-Trial Memorandum as “Exhibit A”.

B. The legal and factual issues regarding the property and debts that are in dispute are:

1. __________________________________________________________________

2. __________________________________________________________________

3. __________________________________________________________________

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4. __________________________________________________________________

VI.

ATTORNEY’S FEES

A. (CHECK ONLY ONE BOX)

G (Check one that applies to you) G Plaintiff/ G Defendant is not requesting attorney’s fees

and costs.

OR

G (Check one that applies to you) G Plaintiff/ G Defendant is requesting attorney’s fees and

costs in the amount of $________________. Of this amount, $___________ has already

been paid and $_______________ is still owed.

VII.

LIST OF WITNESSES

A. (Check one that applies to you) G Plaintiff/ G Defendant intends to call the following

witnesses:

1. Name: ________________________________________; Testimony:__________

__________________________________________________________________

2. Name: ________________________________________; Testimony:__________

__________________________________________________________________

3. Name: ________________________________________; Testimony:__________

__________________________________________________________________

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__________________________________________________________________

VIII.

LIST OF EXHIBITS

A. (Check one that applies to you) G Plaintiff/ G Defendant intends to introduce the following

exhibits at trial:

1. __________________________________________________________________

2. __________________________________________________________________

3. __________________________________________________________________

4. __________________________________________________________________

5. __________________________________________________________________

6. __________________________________________________________________

IX.

UNUSUAL LEGAL OR FACTUAL ISSUES PRESENTED

A. (Check one that applies to you) G Plaintiff/ G Defendant believes the following unusual

issues may be presented at trial:______________________________________________

________________________________________________________________________

X.

LENGTH OF TRIAL

A. (Check one that applies to you) G Plaintiff/ G Defendant believes that this trial should take

approximately ______ (check one) G days/ G hours.

XI.

AFFIDAVIT OF FINANCIAL CONDITION

(CHECK ONLY ONE BOX)

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G (Check one that applies to you) G Plaintiff/ G Defendant filed an Affidavit of

Financial Condition on (date) ______________________. (Check one) G Plaintiff’s/ G

Defendant’s financial circumstances have not changed since that date and that document is

attached as “Exhibit B”.

OR

G (Check one that applies to you) G Plaintiff/ G Defendant previously filed an Affidavit of

Financial Condition on (date) ___________________. However, (check one) G Plaintiff’s/

G Defendant’s financial circumstances have changed. An updated Affidavit of Financial

Condition will be filed at the same time as this Pre-Trial Memorandum and an unfiled copy is

attached as “Exhibit B”.

OR

G (Check one that applies to you) G Plaintiff/ G Defendant has never filed an Affidavit of

Financial Condition. That document will be filed at the same time as this Pre-Trial

Memorandum and an unfiled copy is attached as “Exhibit B”.

OR

G There are no children and no spousal support issues. Therefore, no Affidavit of Financial

Condition has been attached to this Pre-Trial Memorandum.

DATED this (day) ______ day of (month) ______________, (year) ___________.

By:

(Your signature) __________________________

(Your name) __________________________

(Address) __________________________

__________________________

(Telephone) __________________________

In Proper Person

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DEBT SCHEDULE

Creditor Amount

Owed

Assets Securing

Obligation

Proposed Resolution

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ASSET SCHEDULE

Asset

Your Gross

Manner in

which title is

held

Name of creditor with

secured obligation on

asset & loan balance

Proposed

Distribution

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EXHIBIT A

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EXHIBIT B

©Clark County Family Law Self-Help Center Certmail.6

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CERT

(Your Name) __________________________________

(Address) __________________________________

__________________________________

(Telephone) __________________________________

In Proper Person

DISTRICT COURT

CLARK COUNT, NEVADA

)

________________________, ) Case No. _____________

Plaintiff, )

vs. ) Dept No. _____________

________________________, )

Defendant. )

______________________________)

CERTIFICATE OF MAILING

I HEREBY CERTIFY that service of the (name of document)______________________

_________________________________ was made on (date)___________________pursuant to

NRCP 5(b) by depositing a copy of same in the United States Mail in Las Vegas, Nevada,

postage prepaid, addressed as follows:

(Other party’s name) ________________________________

(Other party’s address) ________________________________

(Address) ________________________________

DATED this _________ day of ________________________, (year) ___________.

(Signature of person who mailed document) ___________________________________

(Name of person who mailed document) ___________________________________

Signed and sworn to (or affirmed) before

me on (date) _____________________

by (name of person signing document) __________________________

_______________________________________

Signature of notarial officer

GENERAL INSTRUCTION

The form consists of seven (7) printed pages, plus these instructions. If your form does not have all pages,

you may purchase a complete set from the Clark County Clerk’s Office or the Self Help Center at the Family Courts

& Services Center. You may download a free copy from the Self-Help Center’s website at

http://www.co.clark.nv.us/distcrt/self_help_center.htm.

Answer and complete all sections in this form. If an item requiring your response is not applicable, write

“N/A” in that section.

Use separate sheets of paper if additional space is needed. Any extra sheets must be the same size as the pages

of this form, and all extra pages must be attached to this form when it is filed.

You must initial all pages, including any extra pages you attach to this form, in the lower right corner of each page.

This form must be completed honestly and to the best of your knowledge after reasonable inquiry. This

form has important legal consequences. You should carefully consider each of your answers. If necessary, you

should consult with legal counsel, or if you are representing yourself, ask for clarification when the Court hears your

case.

This form must be filed and served with any motion for child support, temporary spousal support, fees

allowances, exclusive possession of the community residence, modification of any support order, or any other

matter involving the issue of money to be paid by a party. It also must be filed and served by the responding party

with any response or answer to such motion.

If you do not complete this form, or fail to file it on time, or misrepresent facts within it, the Court may impose

sanctions against you. You may have to pay the others party’s fees. If you are the party requesting financial relief,

the Court may presume that you do not need the monetary relief you are seeking. If you are the party being

requested to provide financial relief, the Court may presume that you have the ability to pay any amount requested

by the other party.

During the time that your case is pending before the Court to resolve any issue, you must:

a) File an amended Affidavit of Financial Condition immediately after you get information, which changes

any part or section of this form.

b) Serve the amended Affidavit of Financial Condition in a timely manner to opposing party.

Failure to do the above could result in sanctions being imposed against you by the Court.

PART “A” INSTRUCTIONS – PERSONAL INFORMATION

If you are married to someone other than the other party in this case and your current spouse has any

income, list him or her here. In reporting your spouse’s monthly net income, do NOT deduct any amounts that are

VOLUNTARILY taken out of that income, such as contributions to IRA’s, or allotments to savings or to pay bills,

etc. Do NOT list the income of any person other than a spouse, even if that person lives with you.

PART “B” INSTRUCTIONS – MONTHLY INCOME

Gross income includes the total amount of income from any source including, but not limited to, wages paid

by an employer and/or the gross income from any source received by a self-employed person after deduction of all

legitimate business expenses, but without deduction for personal income taxes, contributions for retirement

benefits, contributions to a pension, or for any other personal expenses. Gross income also includes pay received

from military reserve or National Guard duty, or from a second job. If your income varies from month to month, list

your average monthly income and state how many months you averaged to get your result. BE PREPARED TO

SUPPLY DOCUMENTATION OF YOUR INCOME UPON REQUEST BY THE OTHER PARTY OR BY THE

COURT.

PART “C” INSTRUCTIONS – MONTHLY EXPENSES

This section provides the Court with information regarding your monthly expenses and your total liabilities

for your debts. NOTE: ONLY list expenses you are paying for yourself and any minor children who currently live

with you. If you are remarried, you may also include expenses incurred by your current spouse. ALL amounts in

this section are presumed to be monthly averages unless you specifically state otherwise. If necessary, you may

include a written explanation concerning how you arrived at any amount listed. If you need additional room,

complete “Additional Comments about Part “C” – page 7.

DO NOT list expenses you are not legally required to pay, such as personal debts of an adult person living with you

to whom you are not married.

One time expenses due now or within the next 90 days: Use this section to list any one-time expenses that are not

expected to recur on a regular basis, but which are now due, or will become due within 90 days of the date this

form is completed. This could include such items as extraordinary medical expenses that are already planned.

PART “D” INSTRUCTIONS – ASSETS

This section provides the Court with information regarding the property (assets) that you own. If you are

married, list all the property currently in the possession or under the control of both you and the other party, or

items which you have sold or transferred within the last 6 months. If you are no longer married to the other party,

list all property in your possession or under your control.

If you need additional room, complete “EXHIBIT “2” – page 6

PART “E” INSTRUCTIONS – ATTORNEY’S FEES AND COSTS STATEMENT

This section is used to provide the Court with information regarding the payment of fees or financial

arrangements you have made with your attorney.

EIGHTH JUDICIAL DISTRICT COURT

FAMILY DIVISION

CLARK COUNTY, NEVADA

)

) Case No. ____________

Plaintiff, )

) Dept. No. ____________

-vs- )

)

) Date of Hearing: ____________________

)

Defendant,

) Time of Hearing: ____________________

AFFIDAVIT OF FINANCIAL CONDITION

PART “A” PERSONAL INFORMATION

(Print or Type)

1. Name: __ _____

2. Age: ___________________ _______

3. Occupation:

4. Employer: _____________________ ______

5. City & State of Residence: ________________________

_____ 6. Length of time at current job: _______________

7a. FAMILY RESIDENCE TABLE. In the table below, insert the names and ages of each person living primarily with you.

Only list the persons who live with you more than half of the time. Check the appropriate box if the person named is a child

of either marriage/relationship or some other marriage/relationship. If the named individual is not a child, specify that

person’s relationship to you (husband, aunt, friend, significant other, etc.). If there are more persons living with you than will

fit in the table below, attach a sheet with the same information for those persons as is set out in the table.

NAME AGE

MINOR CHILD

OF THIS MARRIAGE/

RELATIONSHIP

MINOR CHILD NOT

OF THIS MARRIAGE/

RELATIONSHIP

OTHER

RELATIONSHIP

(SPECIFY)

7b. If you are supporting (or are obligated to support) any person who is NOT living with you more than half of the time,

please attach separate sheet listing the names and ages of such person(s) and your relationship with such person(s).

8. If you are divorced from the other party in this action, are you remarried?

. If so, is your current spouse

employed?

. What is your spouse’s hourly rate of pay or monthly gross pay if not paid hourly? ______________

per ___________ _

. What is your spouse’s current monthly net income (i.e. income after deducting federal income

taxes, Social Security, and other INVOLUNTARY deductions? $

.

ADDITION COMMENTS ABOUT PART “A”:________________________________________________________________

___________________________________________________________________________________________________

U: A.F.C\AFC page 1 1 ______

Revised. 12/06 INITIAL

PART “B”-- MONTHLY INCOME & RECEIPTS

1. Hourly or other rate of pay: $__________________________ per ___________________________.

(hour/week/month/year)

2. GROSS (i.e. Total) monthly income earned by working from ALL sources:

NOTE: Include overtime and extra job income and specify here what portion monthly is average.

Overtime: $_________________or extra job income: $____________________ ............................ +$ ________

3. Court ordered or voluntary payments you receive monthly from the other party to this action for your

own support +$ ________

4. Spousal support or alimony you receive monthly from anyone OTHER THAN the party to this action:

State name(s) of source you receive this from:

_________________________________________________________________________

_________________________________________________________________________ +$ ________

5. Child support you receive for children of this marriage/relationship:

If you receive this from a source other than the party to this action:

_________________________________________________________________________

_________________________________________________________________________ +$ ________

6. Child support you receive for children NOT of this marriage/relationship:

State name(s) of source you receive this from:

_________________________________________________________________________

_________________________________________________________________________ +$ ________

7. Total from “Other Income” section of EXHIBIT “1” , including all passive income (retirement,

pension, or dividend payments, etc.) and monies or assistance with your monthly expenses

received from other sources (including spouses, relatives, etc.). Note that if there is ANY

additional income, you MUST complete the “Other Income” section of EXHIBIT “1” page 4 +$ _________

8. TOTAL gross monthly income (total of 1-7): =$ _________

9. LESS Federal Income Tax withheld per month (or, if self-employed, your average monthly

Federal Income Tax actually paid): --$ _________

10. LESS Social Security withheld per month (or, if self-employed, your average monthly

Social Security or INVOLUNTARY retirement payment actually paid): --$ _________

11. LESS any other INVOLUNTARY deductions from your salary (you must detail on a separate

sheet what is in this category and how much is withheld for each item per month: --$ _________

12. Your monthly net income (subtract Lines 9, 10, and 11 from Line 8): .....................................................=$ _________

ADDITIONAL COMMENTS ABOUT PART “B”

_________________________________________________________________________________________________

U: A.F.C\AFC page 2 2 ______

Rev. 12/06 INITIAL

PART “C”-- MONTHLY EXPENSES

1. Court ordered/voluntary payments you pay monthly to the other party to this action for support: ..................................... $______________

2. Spousal support or alimony you pay monthly to anyone other than the other party to this action: ..................................+ $ ______________

3. Child support you pay for children of this marriage/relationship:................................................................... + $ ____________

4. Child support you pay for children NOT of this marriage/relationship:

(specify to whom paid and names and current ages of these children on attached sheet) ................... + $ ____________

5. Rent or house payment (principal, interest, taxes, insurance, and association dues only):.......................... + $ ____________

6. Utilities (except telephone): ........................................................................................................................... + $ ____________

7. Telephone (total, but itemized): Basic$______ Long Distance $_______ Special Features$______.......... + $ ____________

8. Food (total, but itemize): Groceries $_________________ Dining Out $__________________......... + $ ____________

9. Clothing (total, but itemize): Self $______________________ Children $____________________........ + $ ____________

10. Laundry and dry cleaning: ............................................................................................................................. + $ ____________

11. Average monthly health costs you are paying that are not reimbursed by the other party or insurance ...... + $ ____________

(total, but itemize below – See Instructions):

PERSON MEDICAL DENTAL OPTICAL PSYCHOLOGICAL OTHER

YOURSELF

CHILDREN

12. Monthly medical insurance premiums you are currently paying:................................................................... + $ ____________

13. Monthly life insurance premium payment (state if term or whole life:____________): ................................. + $ ____________

14. Auto (total, but itemize):Gas/Oil $________ Repair/Main. $________ Auto Insurance: $________ .......... + $ ____________

15. Child care expenses you are paying: To whom? __________________________________________.... + $ ____________

16. Social, entertainment, and recreation expenses: ......................................................................................... + $ ____________

17. Education costs for minor children: Specify:______________________________________________..... + $ ____________

18. Your monthly educational or occupational training costs: Specify:_____________________________..... + $ ____________

19. Retirement or pension benefits voluntarily withheld per month (i.e. IRA, 401K, payroll savings, etc.):......................... + $ ____________

20. Charitable or religious contributions: Specify: ____________________________________________...... + $ ____________

21. Personal care (barber, beauty supplies or costs, nails, etc.):........................................................................ + $ ____________

22. Payment of other monthly bills (write monthly total here from page 4) ........................................................+ $ ____________

23. TOTAL MONTHLY EXPENSES (add lines 1 – 22): ..................................................................................... = $ ____________

24. Subtract your total monthly expenses (Line 23 in Part “C”) from your monthly net

income (Line 12 in Part “B”) ........................................................................................

(circle one) + / - $ ____________

25. Other one-time expenses now due (write monthly total here from page 4 “One-Time Expenses Due Now

or Within 90 Days” section of EXHIBIT “1”): ..................................................................................................$ ____________

U: A.F.C\AFC 3 ______

Rev. 12/06 INITIAL

EXHIBIT 1

OTHER INCOME

SOURCE AMOUNT EXPLANATION

INCOME:

OTHER MONIES RECEIVED

TOTAL OTHER INCOME

(Enter on Line 7 of Part “B”)

Note: Use Additional sheet(s) If more space is needed

MONTHLY BILLS

CREDITOR

TOTAL

OWED

MINIMUM

MONTHLY

PAYMENT

ACTUAL

MONTHLY

PAYMENT

EXPLANATION

Total Minimum Monthly Bills:

(Enter on Line 22 Part “C”

ONE TIME EXPENSES DUE NOW OR WITHIN 90 DAYS

CREDITOR TOTAL OWED EXPLANATION

TOTAL ONE TIME EXPENSES

(Enter on Line 25 of Part “C”)

NOTE: Use additional sheet(s) if more space is needed

U: A.F.C\AFC

4 ______

Rev. 12/06 INITIAL

PART “D” – ASSETS

If you are married to the other party, list all the property currently in the possession or under the control of both you and the other party, or items

which you have sold or transferred within the last 6 months. If you are no longer married to the other party, list all property in your possession or

under your control. For each item listed below, if all information does not fit in the space provided you must attach a separate page(s) as needed

and specify each additional asset, its gross fair market value, the amount of any secured debt on it, and its net value.

DESCRIPTION

WHO HAS

POSSESSION

GROSS

FAIR

MARKET

VALUE

MINUS

AMOUNT

OF

SECURED

DEBT

EQUALS

NET

VALUE

1. Cash on hand, in banks, credit unions, etc.

(Specify locations and account number(s) by

bank or institution below or on attached sheet):

- =

2. Stocks, bonds, notes, deeds of trust, etc.

(Specify locations and account number(s) by

company, holder, etc. below or on attached

sheet:

- =

3. Real Estate (name each mortgage holder and

amount of each mortgage)

Home:

Other:

- =

4. Automobile #1 Make:_____________________

Model _______________ Year ____________

- =

5. Automobile #2 Make:____________________

Model _______________ Year ____________

- =

6. Other vehicles, boats, trailers, etc.

(Specify below or on attached sheet):

- =

7. House furniture, furnishings, and appliances

(Specify below or on attached sheet):

- =

8. Life insurance (cash value):

- =

9. Retirement, pension, profit-sharing, annuities

and IRAs (Specify below or on attached sheet):

- =

10. Accounts receivable and pending tax refunds

(Specify dates expected to be received below or

on attached sheets):

- =

11. Partnerships and other business interest

(Specify below or on attached sheet):

- =

12. List combined value of $500.00 or more.

(Use EXHIBIT “2” to specify these assets)

Detail

Possession on

EXHIBIT “2”

- =

TOTAL

-

NOTE: Use EXHIBIT “2" if additional space is needed for items 1-12 of Part “D”

ADDITIONAL COMMENTS ABOUT PART “D”:

___________________________________________________________________________________________________________________

U: A.F.C\AFC

5 ______

Rev. 12/06 INITIAL

EXHIBIT “2"

PROPERTY SCHEDULE

DESCRIPTION

WHO HAS

POSSESSION

GROSS FAIR

MARKET

VALUE

MINUS

AMOUNT

OF

SECURED

DEBT

EQUALS

NET VALUE

- =

TOTAL

Write the Totals on Line 12 of Part “D”

- =

U: A.F.C\AFC 6 ______

Rev. 12/06 INITIAL

ADDITIONAL COMMENTS ABOUT PART “C” (see page 3) : ________________________________________

_________________________________________________________________________________________

PART “E” ATTORNEY’S FEES & COSTS STATEMENT

As of the date I have signed this form, my attorney has been paid, by me or by others on my behalf,

$_____________ for attorney’s fees and costs. My arrangement with my attorney(s) for payment of fees and

costs in the future is as follows:

_________________________________________________________________________________________

DECLARATION

I, ________________________________ declare under penalty of perjury that the foregoing is true and correct.

Executed on___________________________ _____________________________________

(date) (signature)

U: A.F.C\AFC 7 ______

Rev. 12/06 INITIAL

New Policy at the Clerk’s

Office

bring a blank 10X13 envelope when you file your

documents. The clerk will mail your documents to you

after they are reviewed by the judge. The clerk’s office

will pay the postage.

January 1, 2007 (#65, 66, 82)

Please call the Self-Help Center to confirm most current version.

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AFRM

(Your name) _______________________________

(Address) _______________________________

_______________________________

(Telephone) _______________________________

In Proper Person

DISTRICT COURT

CLARK COUNTY, NEVADA

)

______________________________, ) CASE NO.: ________________

Plaintiff, )

vs. ) DEPT. NO.: ________________

)

______________________________, )

Defendant. )

____________________________________)

AFFIRMATION – CASE CONFERENCE REPORT OR PRE-TRIAL MEMORANDUM

Pursuant to NRS 239.030

The undersigned does hereby affirm that the following documents do not contain the

social security number of any person: (check the documents being filed at this time)

G Notice of Early Case Conference G Individual Case Conference Report

G Notice of Joinder G Joint Case Conference Report

G Pre-Trial Memorandum G Affidavit of Financial Condition

G Certificate of Mailing

G Other ______________________________________________________________________

The undersigned does hereby affirm that the following documents contain the social

security number of a person as required by state or federal law or for the administration of a

public program or for an application for a federal or state grant: (check the documents being

filed at this time)

G Other (name of document) _____________________________________________________

(your signature)____________________________ (date) _____________

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