Nevada Revised Statutes Title 9. Security Instruments of Public Utilities; Mortgages; Deeds of Trust; Other Liens § 108.620. Form of notice

The form of the notice required by NRS 108.610 must be substantially as follows:

Notice is hereby given that ________________________________ has rendered services in hospitalization for ________________________________, a person who was injured on the _______ day of the month of _______ of the year _______ in the city of ________________, county of ________________________________, on or about the _______ day of the month of _______ of the year _______; and that ________________________________ (name of claimant) hereby claims a lien upon any money due or owing or any claim for compensation, damages, contribution, settlement or judgment from ________________________________, alleged to have caused the injuries, or any other person, corporation or association liable for the injury. The hospitalization was rendered to the injured person between the _______ day of the month of _______ of the year _______ and the _______ day of the month of _______ of the year _______

That 90 days have not elapsed since the termination of hospitalization; that the claimant's demands for such care or service is in the sum of $ ________________ and that no part thereof has been paid except $ ________________; and that there is now due and owing and remaining unpaid of such sum, after deducting all credits and offsets, the sum of $ ________________, in which amount lien is hereby claimed.

I, ________________________________, being first duly sworn, on oath say:

That I am ________________________________, named in the foregoing claim of lien; that I have read the same and know the contents thereof and believe the same to be true.

Subscribed and sworn to before me this _______ day of the month of _______ of the year _______