STATE OF NEVADA
DEPARTMENT OF BUSINESS AND INDUSTRY
REAL ESTATE DIVISION
OFFICE OF THE OMBUDSMAN FOR OWNERS IN
COMMON-INTEREST COMMUNITIES AND CONDOMINIUM HOTELS
3300 W. Sahara Ave., Suite 350, Las Vegas, Nevada 89102
(702) 486-4480 * Toll free: (877) 829-9907
E-mail: CICOmbudsman@red.nv.gov http://red.nv.gov
Revised: 03/13/12 520B
ALTERNATIVE DISPUTE RESOLUTION (ADR)
ADDITIONAL RESPONDENT FORM
This form should only be used in conjunction with Form #520 - ADR Claim Form
Date: ________________ ________________________________________________
Signature of Claimant (
if Homeowner, must be owner of record
)
___________________________ (http://nvsos.gov/sos)
If filed on behalf of the Association, provide the Association’s Entity Number as it appears on the Secretary of State’s website.
Respondent: _____________________________________________________ #_____________________________
If individual provide full name. If Association, provide COMPLETE Association name and Entity Number as it appears on the Secretary of State’s website.
Contact Address: _________________________________________________________________________________
Street City State Zip Code
Contact Phone: ___________________ Fax: ___________________E-Mail:____________________
Respondent: _____________________________________________________ #_____________________________
If individual provide full name. If Association, provide COMPLETE Association name and Entity Number as it appears on the Secretary of State’s website.
Contact Address: _________________________________________________________________________________
Street City State Zip Code
Contact Phone: ___________________ Fax: ___________________E-Mail:____________________
Respondent: _____________________________________________________ #_____________________________
If individual provide full name. If Association, provide COMPLETE Association name and Entity Number as it appears on the Secretary of State’s website.
Contact Address: _________________________________________________________________________________
Street City State Zip Code
Contact Phone: ___________________ Fax: ___________________E-Mail:____________________
Respondent:
_____________________________________________________ #_____________________________
If individual provide full name. If Association, provide COMPLETE Association name and Entity Number as it appears on the Secretary of State’s website.
Contact Address: _________________________________________________________________________________
Street City State Zip Code
Contact Phone: ___________________ Fax: ___________________E-Mail:____________________
For office use only:
Receipt number: _________ Claim number: ________ Date received: _______________________
