STATE OF NEVADA
DEPARTMENT OF BUSINESS AND INDUSTRY - REAL ESTATE DIVISION
OFFICE OF THE OMBUDSMAN FOR COMMON-INTEREST COMMUNITIES AND CONDOMINIUM HOTELS
2501 East Sahara Avenue, Suite 202 * Las Vegas, NV 89104-4137
(702) 486-4480 * Toll free: (877) 829-9907 * Fax: (702) 486-4520
E-mail:
CICOmbudsman@red.nv.gov
Declaration of Certification
Common-Interest Community Executive Board Member
Each newly elected or appointed executive board member must complete Form 602 within 90 days of his/her
election or appointment and submit a copy of Form 602 to the Division. Only one copy is required, per
election or appointment, to be submitted to the Division at the time of registration NRS 116.31034(15).
I _________________________________________, an elected or appointed member
(print name)
of the executive board of ____________________________________*, a common- interest
(association’s legal name)
community or condominium hotel, Secretary of State (SOS) File#__________________,*
master association of _________________________________**, certify that I have
(master association’s legal name)
read and understand, to the best of my ability, the governing document of the association
and the provisions of Chapter 116 or 116B of Nevada Revised Statutes (NRS) and
Chapter 116 of the Nevada Administrative Code (NAC).
Date of election or appointment to the board ___________/ ________/ __________
month
date
year
“I declare under penalty of perjury under the law of the State of Nevada that the
foregoing is true and correct.”
Executed on ____/____/____
___________________________________
Date
Signature
* Association’s legal name and Secretary of State file number as it appears on the Secretary of State’s web site at:
( )
** If the association belongs to a master planned community, list the legal name of master association.
For office use only
Executive Board Member(s) in Key Mgmt: □Yes
□ No
# of DOCS received: ______________
Date Received: _______________________
Date Processed: ______________________ Processed by (initial): _______________
Revised 8/27/15
Form 602