Landlord Name   
Agent Name   
Street Address   
City, State, Zip   
Telephone   
Email Address   

1. I am the (check one box)
owner 
owner's agent   
of the rental premises located at   insert complete address, including city, state, and zip code   

2. The tenancy started on   Date      

3. The tenancy is a (check one box)
periodic month-to-month   
periodic week-to-week   
fixed-term with the tenancy ending on        Date      
tenancy-at-will   
other      describe   

4. Tenant (check one box)
did  
did not   
sign a written rental agreement, and if so, a copy of that agreement is attached to this Complaint.

check box if additional sheets are attached.     

6. Tenant was served with a written notice to quit on date notice served    in compliance with NRS 40.280, and a copy of that notice and proof of service is submitted with this Complaint.   

7. Tenant was served with a five-day unlawful detainer notice on date notice served     in compliance with NRS 40.280, and a copy of that notice and proof of service is submitted with this Complaint.  

8. On date you last checked the rental premises    , I examined the rental premises and verified the tenant is in possession of the rental premises. In addition, if tenant was served with a Five-Day Notice to Perform Lease Condition or Quit, tenant did not perform that lease condition as of the date of my examination.   

9. Tenant's rent (check one box)
is 
is not 
subsidized by a public housing authority or governmental agency, and a copy of the Housing Assistance Payment Contract (or “HAP”) is attached or submitted with this Complaint and I have provided the Reno Housing Authority with a copy of the eviction notice pursuant to 24 C.F.R. § 982.310(e)(2)(ii).

Dated      

Signature