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Affidavit And Schedule Of Arrearages 3912 - Nevada
| Affidavit And Schedule Of Arrearages Form. This is a Nevada form and can be used in Family District Court Washoe County . |
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1 Code No: 3912 Name: 2 Address: 3 Telephone: 4 Acting in Proper Person 5 IN THE FAMILY DIVISION 6 7 OF THE SECOND JUDICIAL DISTRICT COURT OF THE STATE OF NEVADA 8 IN AND FOR THE COUNTY OF 9 10 11 Plaintiff (Petitioner), Case No: 12 vs. 13 Dept. No: 14 Defendant (Respondent). ________________________________/ 15 16 AFFIDAVIT AND SC HEDULE OF ARREARAGES 17 STATE OF NEVADA ) ) SS: 18 County of ) 19 20 I, , being first duly sworn under penalties (Your Name) 21 of perjury, depose and say: 22 I am owed and entitled to receive certain periodic monthly payments from 23 _______________________________, pursuant to the Order filed with the Court on ___________. 24 (Other Party) (Date Order was issued) _____________________ has failed to make all of the payments when due as set forth in the (Other partys name) 25 attached schedule. The following schedule is a true and accurate statement, so far as I can prove, 26 //// 27 //// 28 //// <<<<<<<<<********>>>>>>>>>>>>> 2 1 of all payments due and received during the months stated. 2 DATED: 3 __________________________________ ( Signature) 4 5 6 7 8 SUBSCRIBED and SWORN to before me 9 this ________ day of ____________, 20__. 10 11 12 ___________________________________ NOTARY PUBLIC 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 <<<<<<<<<********>>>>>>>>>>>>> 3 DUE DATE SET AMOUNT DATE AMOUNT TOTAL BY COURT DUE THIS PAYMENT OF ARREARAGE DECREE/ORDER PAYMENT RECEIVED PAYMENT THIS RECEIVED PAYMENT
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