Nevada Revised Statutes Title 10. Property Rights and Transactions § 118A.347. Form of affidavit for written notice terminating lease due to domestic violence

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    I (and/or) ___________________________________________________________________________________

am a victim of domestic violence as defined in NRS 118A.345.

Brief description of incident(s) constituting domestic violence:

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            The incident(s) that I described above occurred on the following date(s) and time(s), and in the following locations:

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            The incident(s) that I described above were committed by the following person(s):

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            I state under penalty of perjury under the laws of the State of Nevada that the foregoing is true and correct.

            Dated this __________ day of__________, 20__________, at __________ (city), Nevada,

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            I verify that the person whose signature appears above was a victim of domestic violence and that the person informed me of the name of the adverse party as defined in NRS 118A.345.

            Dated this __________ day of __________, 20__________, at __________ (city), Nevada,

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(Signature of qualified third party)