Free Illegal Lockout Request Form- EVMOT128W - Nevada

JUSTICE COURT, LAS VEGAS TOWNSHIP
CLARK COUNTY NEVADA
) )
FOR COURT USE ONLY

) Plaintiff/Tenant(S), ) ) VS ) ) CASE NO. DEPT NO. VERIFIED COMPLAINT FOR EXPEDITED RELIEF

) FOR THE UNLAWFUL REMOVAL OR EXCLUSION OF THE TENANT OR THE WILLFUL )
INTERRUPTION OF ESSENTIAL SERVICES Defendant/Landlord(S). )

The Tenant named above hereby files this Complaint against the Landlord named above and hereby alleges as follows: 1. PLEASE CHECK ONE OF THE FOLLOWING BOXES: The Landlord has not instituted a pending legal action for summary eviction or a pending legal action for unlawful detainer against me. IF THIS BOX IS CHECKED, YOU CAN USE THIS FORM. The Landlord has instituted a pending legal action for summary eviction or a pending legal action for unlawful detainer or against me, or I have already been locked out pursuant to a prior action. IF THIS BOX IS CHECKED, YOU CANNOT USE THIS FORM. INSTEAD, YOU MUST FILE A "MOTION TO PLACE ON CALENDAR" USING THE CASE NUMBER FOR THE CASE WHICH THE LANDLORD HAS FILED. 2. 3. The parties entered into a rental agreement on or about the The Nevada address for the property at issue is as follows: STREET ADDRESS: CITY: ZIP CODE: 4. PLEASE CHECK ONE OF THE FOLLOWING BOXES: The rental agreement was not in writing. The rental agreement was in writing.* *(PLEASE ATTACH A COPY OF THE RENTAL AGREEMENT IF ONE IS AVAILABLE). 5. 6. The amount of rent is $ PLEASE CHECK ONE OF THE FOLLOWING BOXES: I pay rent weekly. I pay rent monthly. I pay rent as follows: day of
SELECT January

, 20

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7.

PLEASE CHECK ONE OF THE FOLLOWING BOXES: My rent payments are current. My rent is not current I am $ in arrears. day of , 20 .

8. 9.

My next rental payment is due on the

SELECT January PLEASE CHECK ONE OF THE FOLLOWING BOXES:

The Landlord barred me from entering my dwelling unit on or about the day of , 20 . The Landlord terminated my utilities or other essential services on or day of , 20 . NOTE: If the power/gas/water company terminated your utilities for unpaid bills, you will not be entitled to relief from the Court. NOTE: This complaint is required to be filed 5 judicial days after the date of the unlawful act by the Landlord. If this time period has been exceeded, this Complaint for Expedited Relief will be dismissed, but you will retain the right to pursue all other available remedies against the landlord. 10. PLEASE DESCRIBE THE FACTUAL CIRCUMSTANCES SURROUNDING THE BLOCKED ENTRY AND/OR THE TERMINATION OF ESSENTIAL SERVICES: (For example, if you were barred from entry, please describe how it was done. If your utilities were terminated, please state which utilities were affected). NOTE: Please make sure that the information you provide is LEGIBLE.

11. PLEASE CHECK ONE OR BOTH OF THE FOLLOWING BOXES: After I was blocked entry to the premises, I tried to get back into the dwelling, but the Landlord refused to let me in. (If available, please attach a copy of any letters sent to, or from, the Defendant Landlord). After the Defendant Landlord terminated my utilities or other essential services, I tried to convince the Defendant Landlord to restore the services, but the Landlord Refused. (If available, please attach a copy of any letters sent to, or from, the Defendant Landlord).

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12. As a result of the Defendant Landlord's actions, I have incurred damages as follows: In addition to statutory damages of $1,000.00 allowed under NRS 118A.390, I am seeking to be compensated for the following items of damages: AMOUNT: $ $ $ 13. Based on the above, Plaintiff Tenant requests that this Court: (a) Find that the Defendant Landlord has violated NRS 118A.390 and/or NRS 118A.480; (b) Assess actual and statutory damages against the Defendant Landlord not to exceed the jurisdictional limit ($7,500.00) of Justice Court; (c) Issue an immediate order restoring me to the premises and/or restoring the utilities or essential services; and (d) Enjoin the Landlord for violating the provisions of NRS 118A.390 and, if the circumstances so warrant, hold the Landlord in contempt; 14. VERIFICATION: I have read the forgoing Verified Complaint and know the contents thereof, and the contents are true of my own knowledge except for those matters therein stated on information and belief, and as to those matters, I believe them to be true. DATED this BY: (Plaintiff's Signature) 15. PLEASE COMPLETE SECTION 1 OR 2 BELOW (1) NOTARY: Signed and Sworn to or Affirmed Before Me This day of PLEASE STAMP BELOW: , 20 . day of , 20 . DESCRIPTION:

Notary Public (2) UNSWORN 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)

NOTE: Unless this complaint is dismissed for the reasons stated above, the Court will conduct a hearing on this Verified Complaint for Expedited Relief within 3 judicial days after the date this document is filed. Either before or at the scheduled hearing, you must provide proof that the Landlord has been properly served with this document, or you will be entitled to no relief.

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THIS ENTIRE PAGE IS TO BE COMPLETED BY COURT STAFF:
NOTICE OF MOTION

TO:

(Landlord)

You will please take notice that a hearing will be held on this "Verified Complaint for Expedited Relief for the Unlawful Removal or Exclusion of the Tenant or the Willful Interruption of Essential Services." This hearing will take place on: at In DEPARTMENT: Street Address: City, State, Zip Although you are not required to fill a written response to the Motion, failure to appear at the hearing may result in the requested relief being granted by the Court in your absence. The purpose of this hearing is to address the Tenant's right to be immediately restored to the premises and/or the Tenant's right to have utilities or other essential services restored. Moreover, Tenant may also be entitled to an award of damages against you, so you may wish to consult with an attorney prior to the scheduled hearing. AM/PM

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EVMOT128W Rev. 10/28/03

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