Free Elderly or Disabled Tenant's Affidavit to Remain in Leased Premises 30 Days - Nevada

JUSTICE COURT, LAS VEGAS TOWNSHIP CLARK COUNTY, NEVADA TENANT: _____________________________ ) ) _____________________________ ) ) ADDRESS: _____________________________ ) ) _____________________________ ) ) _____________________________ ) ) PHONE #: __________________ ) ) ) vs. ) ) ) __________________________________. ) LANDLORD ) ) __________________________________________) AFFIDAVIT The above named Tenant, being first duly sworn, deposes and says: (A) Please check the appropriate box below: The length of my lease agreement with Landlord is based on the following: [ ] [ ] [ ] The lease is indefinite with no specific expiration date. The lease is based on monthly rental payments. The lease is based on weekly rental payments. NOTE: If you have a weekly tenancy, you are not eligible to request any extension of time pursuant to this application. The lease is based on the following: _____________________________ ____________________________________________________________

IN THE MATTER OF TENANT' REQUEST S TO CONTINUE IN POSSESSION (ELDERLY OR DISABLED TENANTS ONLY) Case No._____________________ Dept. No. ________

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(B) Please check the appropriate box(es) below: I am: [ ] 60 years of age or older, as shown by sufficient proof attached to this Application.

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Physically or mentally disabled, as shown by sufficient proof attached to this Application.

(C) Please check the appropriate box(es) below: [ ] I have provided Landlord with a written request to continue in possession for an additional 30 days, and I have provided Landlord with sufficient proof of my age and/or disability, but Landlord refused to provide any extension of time. I have not provided Landlord with a written request to continue in possession for an additional 30 days, and/or I have not provided Landlord with proof of my age and/or disability. NOTE: If this box is checked, you are not eligible to request any extension of time pursuant to this application.

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Based on the above, I therefore request that the Court order Landlord to allow me to remain in possession for an additional 30 days.

DECLARATION (Per NRS 53.045): "I declare under penalty of perjury under the law of the State of Nevada that the foregoing is true and correct." Executed on ___________________ (Date) ___________________________________ (Signature)

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EVAFF129W
Rev 08/2004