STATE OF NEVADA
DEPARTMENT OF BUSINESS AND INDUSTRY
REAL ESTATE DIVISION
OFFICE OF THE OMBUDSMAN FOR OWNERS IN
COMMON-INTEREST COMMUNITIES AND CONDOMINIUM HOTELS
1179 Fairview Drive, Suite E * Carson City, NV 89701-5453 * (775) 687-4280
2501 East Sahara Avenue, Suite 202 * Las Vegas, NV 89104-4137
(702) 486-4480 * Toll free: (877) 829-9907
E-mail:
CICOmbudsman@red.state.nv.us
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)
(https://esos.state.nv.us/SOSServices/AnonymousAccess/CorpSearch/CorpSearch.aspx)
___________________________
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: _______________________
Revised: 03/13/12
520B