Affidavit Court Form Nevada Page 2

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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.
[ ]
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.
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)
2
EVAFF129W
Rev 08/2004

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