IN THE JUSTICE COURT OF SPARKS TOWNSHIP
COUNTY OF WASHOE, STATE OF NEVADA
Plaintiff(s)/Landlord(s)/Owner(s), Plaintiff(s)/Landlord(s)/Owner(s)
vs.
Defendant(s)/Tenant(s), Defendant(s)/Tenant(s)
I am unable to pay the costs of prosecuting or defending this action. I am requesting, pursuant to NRS 65.040 and NRS 12.015, to proceed without paying costs or fees, based on the following:
Medicaid Public Housing SNAP SSD Other Description for "Other"I am a client of Legal Aid. Notice of Representation, attached. 2. Including me, there are/is Number of Adults adult(s) and Number of Childrenchild(ren) that I am financially responsible for in my household.3. My total household monthly income after taxes, (include income from employment, reportable or non-reportable, rental income, trust income, unemployment compensation, workers’ compensation, child support, Social Security, spouse and or domestic partner’s income, and other household monthly contributions, etc.) is: $ Enter Income.Pursuant to NRS 53.045, I declare under penalty of perjury under the law of the State of Nevada that the forgoing is true and correct.Print Name:Print NameSignature: Signature Date: Date