Schedule Of Arrearages {SCHD}

1 SCHD 2 3 4 5 DISTRICT COURT 6 CLARK COUNTY, NEVADA 7 8 9 Plaintiff(s), 10 CASE NO. -vs- 11 DEPT. NO. 12 13 Defendant(s). 14 15 16 SCHEDULE OF ARREARAGES 17 ST AT E O F ) 18 ) ss: COUNT Y OF ) 19 20 , being first sworn, deposes and says: 21 I am owed and entitled to receive certain periodic monthly payments from 22 23 pursuant to filed with the Court on . A copy of the relevant provision of that 24 is attached to this schedule. has failed to make all of those payments 25 when due as set forth herein. The following schedule is a true and accurate statement 26 of all payment due dates and of any payments re ceived by me during the months noted. 27 Further, affiant sayeth naught. 28 Schedul e Of Arrearages {SCHD}.doc/3/16/2005 American LegalNet, Inc. www.USCourtForms.com <<<<<<<<<********>>>>>>>>>>>>> 2 1 I declare under penalty of perjury under the law of the State of Nevada that the 2 foregoing is true and correct. 3 EXECUTED this d ay o f , 20 . 4 _____________________________________ 5 Affiant 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 2 Schedul e Of Arrearages {SCHD}.doc/3/16/2005 American LegalNet, Inc. www.USCourtForms.com <<<<<<<<<********>>>>>>>>>>>>> 3 1 DUE DATE SET AMOUNT DUE THIS DATE PAYMENT AMOUNT OF TOTAL 2 BY COURT DECREE PAYMENT RECEIVED THIS MO. PAYMENT RECEIVED ARREARAGES THIS MONTH 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 (PLEASE USE ADDITIONAL PAGES FOR ADDITIONAL ENTRIES) 3 Schedule Of Arrearages {SCHD}.doc/3/16/2005 American LegalNet, Inc. www.USCourtForms.com