IN THE JUSTICE COURT OF RENO TOWNSHIP
COUNTY OF WASHOE, STATE OF NEVADA
________________
________________
_____________________________________
Case No. ____________________
Plaintiff/Landlord,
Dept. No.____________________
MOTION TO PROCEED
Vs.
IN FORMA PAUPERIS
_____________________________________
Defendant/Tenant.
MOTION
Based on the following affidavit, (name) _________________________ requests this court for permission to file
a (check one):
Lawsuit or eviction notice
Defense to lawsuit or eviction notice
without paying court costs or sheriff fees and alleges that he/she has a meritorious claim or defense, yet lacks sufficient
financial ability to pay the costs to proceed.
AFFIDAVIT
STATE OF NEVADA
)
) ss:
COUNTY OF WASHOE )
I, (name) ___________________________________________________ declare under penalty of perjury that the
statements of this affidavit are true and that the responses I have made to the questions regarding my ability to pay are
true:
1)
I am the (check one) plaintiff defendant landlord tenant.
2)
I wish to file with this court a (check one) lawsuit or eviction notice defense to lawsuit or eviction
notice.
3)
I believe in good faith that I have a valid claim or meritorious defense, namely (state briefly your claim or
defense and/or attach the document you wish to file if this motion is granted):
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
4)
I cannot pay the costs of this action, as I lack sufficient income, assets or other resources.
5)
There are ________ persons in my household, including myself. (If any household members are
dependent upon you for support, state their ages and relationships to you: _________________________
___________________________________________________________________________________________
6)
My total household monthly income is $_________________________ and is derived from the following
sources:
My wages
$__________________
Wages of employed household members
$__________________
ADC
$__________________
General Assistance
$__________________
Social Security
$__________________
1
2
