Victim Information Worksheet | Pdf Fpdf Doc Docx | Nevada

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Victim Information Worksheet | Pdf Fpdf Doc Docx | Nevada

Victim Information Worksheet

This is a Nevada form that can be used for Workplace Harassment within County, Clark, Justice Court, Las Vegas Township.

Alternate TextLast updated: 5/16/2006

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JUSTICE COURT, LAS VEGAS TOWNSHIP CLARK COUNTY, NEVADA VICTIM INFORMATION WORKSHEET Business Name: ___________________________________________________________ AKA (if applicable): ___________________________________________________________ Address: ___________________________________________________________ City: ___________________ State: ____________ Zip Code: ______________ Business Telephone Number: _________________________________________ Business Fax Number: _________________________________________ Business E-Mail Address (if applicable): _________________________________________ Business Web Address (if applicable): _________________________________________ Authorized Agent for Plaintiff: _________________________________________ Direct Telephone Number for Authorized Agent: ____________________________________ PLEASE ANSWER THE FOLLOWING QUESTIONS: (1) Does this business have a prior relationship with the Defendant ? (For example, is the Defendant a former employee/customer/neighboring business owner/etc.?)  Yes. (Please describe the relationship.) __________________________________ ______________________________________________________________________  No. (2) Have there been any other court actions between your business and the Defendan t?  Yes. (Please describe the prior court actions.) ____________________________ ______________________________________________________________________  No. (3) Are there specific employees and/or customers who are the focus of the harassment?  Yes. (Please list the names and job titles, if applicable, of all individuals.) ______________________________________________________________________ ______________________________________________________________________  No. (4) Is the business being represented by an attorney who will appear in this case?  Yes. NAME: _____________________________________________________ ADDRESS: _____________________________________________________ PHONE: _____________________________________________________  No. CONFIDENTIAL 1

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