RENO JUSTICE LOCKOUT PACKET
LANDLORD AFFIDAVIT * CASE COVER SHEET * WCSD INSTRUCTION SHEET
Landlord's
Name:
Preferred Pronoun(s)
Agent's Name:
LANDLORD Address:
LANLORD City, State, Zip:
LANDLORD Phone:
LANDLORD Email:
Landlord,
vs.
Tenant'sName:
Preferred Pronoun(s)
TENANTS Address:
TENANTS City, State, Zip:
TENANT Phone:
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TENANT Email:
Landlord or Landlord's authorized agent states as follows pursuant to NRS 40.253: (if completing by hand, please print in clear, legible ink. Illegible documents may be summarily dismissed by the Court):
1. I am the (check one box) owner or owner's agent of the rental premises located
owner or
owner's agent of the rental premises
2. The Tenancy started on (insert date)
at (insert complete address of rental unit, including city, state and zip
3. The amount of Tenant's rent is (insert amount) $
month, week, or other (specify)
month,
week,
other (specify)
other (Specify)
4. (Initial) I verify that the amount of periodic rent referenced in paragraph 3 above has been set forth in the tenant's rental agreement as a single figure representing the maximum total amount of periodic rent inclusive of all mandatory fees pursuant to NRS 118A.200 as amended by Assembly Bill 121 (2025). Alternatively, the amount of periodic
YOUR INITIALS HERE
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rent has not been set forth as a single figure representing the maximum total amount of periodic rent inclusive all mandatory fees for the following reasons:
The tenant's rental agreement predates the October 1, 2025, effective date of AB
The tenant's rent includes mandatory monthly fees for electric, natural gas, and/or service that has been charged to the tenant consistent with the requirements of AB 121;
There is no written rental agreement with the tenant; or
Other (please explain)
If you selected Other (PLEASE EXPLAIN)
5. Tenant paid the following deposits (insert amounts): Rent deposit of $
Security deposit of $:
and cleaning deposit of $:
6. Tenant's rent became delinquent on (insert date)
and Tenant has remained in possession without paying rent since that date.
7. I verified Tenant continued in possession of the rental premises following the expiration of the Notice of Rent or Quit on (insert date you checked rental premises premises)
(insert date you checked rental)
8. Tenant owes the following amounts: in periodic rent $:
in late fees $
other fees $:
(list each fee and amount) $:
additional $
additional $
additional $
TOTAL now due and delinquent. $:
9. Tenant was served with written notice to pay rent or quit on
Served Date of Eviction Notice
10. Tenant (check one box) did not sign a written rental agreement, or did sign a written rental agreement, and a copy of that agreement is attached or submitted with this complaint.
did not sign a written rental agreement, or
did sign
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11. Tenant's rent (check one box) is not, or is subsidzed by a public houseing authority or gonrnmental agency, and a cop of the Houseing Assistance Payment Contract.....Type a question
Tenant's rent is not subsidized
tenant's rent is subsidized
I declare under penalty of perjury that the above statements are true and correct to the best of my knowledge and that the reason for this request is not for the purpose of delay or any other frivolous or improper purposes. I affirm this document does not contain the personal information of any person as defined by NRS 603A.040.
Today's Date
-
Month
-
Day
Year
Date
(Type or Print Your Name)
(Signature)
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JUSTICE / MUNICIPAL CIVIL COURT COVER SHEET
Real Property (Check box)
*
Landlord/Tenant (Summary Eviction)
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WASHOE COUNTY SHERIFF'S OFFICE CIVIL SECTION INSTRUCTIONS FOR EVICTION
LANDLORD/AGENT NAME
LANDLORD/AGENT PHONE NUMBER
Please enter a valid phone number.
Format: (000) 000-0000.
*LANDLORD/AGENT 2ND PHONE NUMBER
Please enter a valid phone number.
Format: (000) 000-0000.
Please complete the following questions to the best of your ability:
*Is this a secure building or gated community?
YES
NO
If YES, please provide the code.
*Will the landlord/ agent provide a locksmith?
YES
NO
UNKNOWN
Has there been recent law enforcement response?
YES
NO
UNKNOWN
*Are there any weapons inside the property?
YES
NO
UNKNOWN
Is the occupant(s) known to carry any weapons?
YES
NO
UNKNOWN
*Do any occupants have a history of violence?
YES
NO
UNKNOWN
*Are there any dogs/animals on the property?
YES
NO
UNKNOWN
If YES, are they aggressive?
YES
NO
UNKNOWN
*Is the property hard to find?
YES
NO
If YES, then please provide additional information below
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