Fillable Lvjcvl Form-22 Proof Of Service - Clark County, Nevada printable pdf download

JUSTICE COURT, LAS VEGAS TOWNSHIP

Case No.

Clark County, Nevada

Name and Address of Plaintiff(s)

Department No.

PROOF OF SERVICE

VERSUS

Name and Address of Defendant(s)

_________________________________________________, being duly sworn or under penalty

(Insert name of person performing service)

of perjury, state that at all times relevant, I was over 18 years of age and not a party to or interested in the above-captioned

case; that I received a copy of the

__________________

_________________________

(insert name of documents you served)

_________________ on

____________________, 20____; and that I served the same on Defendant

(insert date you received documents)

____________________________________________________ on

(insert Defendant's name)

(insert date and time you served the documents)

____________________, 20____, at the hour of ______ __.M., by

(complete appropriate paragraph below):

For personal service per JCRCP 4(d)(6): Delivering and leaving a copy with Defendant at

(insert address at which you served)

________________________________________________________________

___________.

For substitute service per JCRCP 4(d)(6) (other than Orders for Protection): Delivering and leaving a copy with

_______________________________________

(insert name or physical description of person served)

a person of suitable age and discretion residing at Defendant’s dwelling house or usual place of abode, at

(insert Defendant's address)

__________________________________________________________________

________.

For service by registered or certified mail per JCRCP 91 (if allowed): Depositing a copy in a mailbox of the United

States Post Office, enclosed in a sealed envelope, postage prepaid, registered or certified mail, return receipt requested, addressed

to Defendant at

_______

_____ ____________________

(insert Defendant's address):

(A copy of the signed return receipt must be attached.)

For service on a business entity per JCRCP 4(d)(1) or (2): Delivering and leaving a copy with

(insert name or physical description

__________________________________________________, who is Defendant's

[ ] president or other head,

of person served)

(check one)

[ ] secretary, [ ] cashier, [ ] managing agent, [ ] resident agent, or [ ] other

___

________

(specify)

___________________________________________

_________

(insert address at which you served)

Dated: _________________

Signature: ________________________________________________________

_____

 Residential/  Business Address: ___________________________

______________ Phone: _____

You MUST check one of the following boxes AND have this affidavit notarized

or sign the unsworn

(block on the left)

declaration per NRS 53.045

(block on the right):

 I am a licensed process server or an employee of a licensed process server; my license or registration number is

(insert license

______________________________________________.

or registration number):

 I am not required to be licensed under Chapter 648 of the Nevada Revised Statutes or another provision of law because I

am not engaged in the business of serving legal process within the State of Nevada.

SUBSCRIBED AND SWORN to before me this

O R

____ day of ____________________, 20____.

"I declare under penalty of perjury under the law of the State of

Nevada that the foregoing is true and correct."

______________________________________

NOTARY PUBLIC in and for the

__________________________________________

(Signature):

County of ___________

____

_, State of ___

____

_________________________________________

(Date):

Original-File

Copy-Plaintiff

Copy-Defendant

LVJCVL Form -22 Revised 7/11

Lvjcvl Form-22 Proof Of Service - Clark County, Nevada

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