Plaintiff   

Plaintiff,

vs.

Defendant   

Defendant.

Pursuant to NRS 53.045, I declare under penalty of perjury that the forgoing is true and correct.

Dated this   dayday of   month20   year         

Signature:Signature   
Print Name:Print Name   
Address:Address   
City, State, Zip: City, State, Zip   
Telephone Number:Telephone Number   
Email Address:Email Address