Free Assignment - Nevada

JUSTICE COURT, LAS VEGAS TOWNSHIP CLARK COUNTY, NEVADA THE STATE OF NEVADA, ) ) Plaintiff, ) ) vs. ) ) ___________________________, ) ) Defendant. ) ____________________________________)

CASE NO.: _________________ DEPT. NO.: ____

ASSIGNMENT

For value received, I assign to ______________________________________________

all my right, title and interest in bail funds deposited with the LAS VEGAS JUSTICE COURT in

the above entitled case, in the amount of $_______________________________.

Pursuant to NRS 53.045, I declare under penalty of perjury under the law of the State of

Nevada that the foregoing is true and correct.

_______________________ DATE EXECUTED

________________________________________________ SIGNATURE

CRCOR002 rev. 07/2004