Free DOMESTIC VIOLENCE PROTECTION ORDER INFORMATION SHEET - Nevada

*CONFIDENTIAL*
STALKING AND HARASSMENT PROTECTION ORDER INFORMATION (TO BE FILLED OUT BY APPLICANT)
Instructions: Please provide all information known to you and print legibly. All requested information is helpful for service, even if the information is only partially known. Please note that if you do not provide an address for the Adverse Party, or if the sheriff/constable cannot effectuate service at the address you give, Applicant has the ultimate responsibility for having the Adverse Party served by private process server or other means.

APPLICANT DATA Name:
_________________________________________________________________________________________________________________________________ (Last) (First) (Middle)

Phone: Home:
(Last)

Work:
(First)

Cell:
(Middle)

Other Name Used: _________________________________________________________________________________ Additional Contact Person: ________________________ Phone: ____________Address: __________________________ ADVERSE PARTY DATA Other Name Used:
(Last) (First) (Middle) (Last) (First) (Middle)

Full Name: Relationship To You (if any): Last Known Home Address:
(Street Address)

Date of Birth
(Bldg/Apt #)

/

/

and/or Social Security No.:
(Y) (City) (State) (Zip Code)

(M) (D)

Is this address difficult to find? Mailing Address:

No Yes If yes, please explain ______________________________ __________________________________________________________________________________________
(Street Address) (Bldg/Apt #) (Bldg/Apt #) (City) (City) (State) (State) (Zip Code) (Zip Code)

(If different from above)________________________________________________________________________________________

Other Likely Address:
(Street Address)

Home Phone: ______________________________________________ Cell Phone: ______________________________ Occupation: Employer: Work Days: __________ Work Hours: _______ Work Phone: ____________ Work Address:
(Street Address) (City) (State) (Zip Code)

Hair Color: Eye Color: Height: Scars/Marks/Tattoos (Description and Location): Does the Adverse Party speak English?
(Yes or No)

Weight: If not, what language?

Sex

Race:

__________________________________________________________________________________________
Vehicle Make: ________ Model: ________ Year: ________License Plate Number/State: ___________________________ (Circle one)
Are the Applicant and the Adverse Party living together now? Are the Applicant and the Adverse Party employed by the same employer? Is the Adverse Party likely to react violently when served? Is the Adverse Party likely to avoid service? Does the Adverse Party have a Carrying Concealed Weapon (CCW) Permit? Does the Adverse Party have access to weapons? If yes, please describe type and location of weapon(s): Yes or No Yes or No Yes or No Yes or No Yes or No Yes or No

Does the Adverse Party's history include (please circle): assaults, assaults w/weapon, batteries, mental health problems, drug/alcohol abuse, outstanding/prior arrest warrants, safety issues? Explain:

Do not write in this space. For court purposes only. Issuing Court ORI: NV______________ Court Case Number: _______________
Law Enforcement: Do not serve this sheet with documents to be delivered.

STALKING AND HARASSMENT PROTECTION ORDER INFORMATION

*CONFIDENTIAL*
Revised June 2006