Your Name - the Clark County Courts in Las Vegas

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STATE OF NEVADA )
) ss:
COUNTY OF CLARK )
VERIFICATION
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(Your name) _____________________________, under penalties of perjury, being first duly
sworn, deposes and says:
That I am the Plaintiff in the above-entitled action; that I have read the foregoing
Complaint and know the contents thereof; that the same is true of my own knowledge, except for
those matters therein contained stated upon information and belief, and as to those matters, I
believe them to be true.
DATED this (day) _____ day of (month) ___________, 20___.
SUBSCRIBED and SWORN to before me
this ______ day of ________________, 20____.
_______________________________________
NOTARY PUBLIC
STATE OF NEVADA )
)ss:
COUNTY OF CLARK )
On this (day) _______ day of (month)
Submitted By:
____________________________
(your signature)
ACKNOWLEDGMENT
____________________________
(print your name)
, 20___, before me, the
undersigned Notary Public in and for the said County and State, personally appeared (your name)
, known to me to be the person described in
and who executed the foregoing Complaint and who acknowledged to me that he/she did so freely
and voluntarily and for the uses and purposes therein mentioned.
WITNESS my hand and official seal.
___________________________________
NOTARY PUBLIC
©Clark County Family Law Self-Help Center
Rev. 4/1/11
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Packet 67, 68 & 69 2010.doc
ALL RIGHTS RESERVED