IN THE JUSTICE COURT OF RENO TOWNSHIP
COUNTY OF WASHOE, STATE OF NEVADA
Case No. ____________________
MOTION TO PROCEED
IN FORMA PAUPERIS
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.
STATE OF NEVADA
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
I am the (check one) plaintiff defendant landlord tenant.
I wish to file with this court a (check one) lawsuit or eviction notice defense to lawsuit or eviction
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):
I cannot pay the costs of this action, as I lack sufficient income, assets or other resources.
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: _________________________
My total household monthly income is $_________________________ and is derived from the following
Wages of employed household members