1

(Name)
2
(Address)
3
(City, State, Zip)
4
(Telephone)
5 G Plaintiff/ G Defendant, Pro Se
6
JUSTICE COURT, __________________________ TOWNSHIP
7
CLARK COUNTY, NEVADA
8
)
9 , ) Case No.:
) Dept. No.:
10 Plaintiff(s), )
)
11 vs. )
)
12 )
, )
13 ) Date of Hearing: N/A
Defendant(s). ) Time of Hearing: N/A
14 )
15 STATEMENT OF POINTS ON APPEAL

16 Pursuant to JCRCP 74(d), Appellant hereby submits the

17 following statement of points upon which Appellant intends to rely on appeal (provide a brief

18 statement of facts and legal argument on why you’re entitled to appellate relief, including what happened at your

19 hearing):

20

21

22

23

24

25

26

27

28

© Civil Law Self-Help Center Page 1

Clark County, Nevada
 1

10

11

12

13

14

15

16

17

18

19

20

21

22

23 DATED this day of , 20 .

24 Pursuant to NRS 53.045, I declare under penalty of
perjury that the foregoing is true and correct.
25

26 (signature)
(print name)
27 G Plaintiff/ G Defendant, Pro Se
28

© Civil Law Self-Help Center Page 2

Clark County, Nevada
 1 CERTIFICATE OF MAILING

2 I HEREBY CERTIFY that service of the foregoing STATEMENT OF POINTS ON

3 APPEAL was made on (insert date) ____________________________, 20_____, pursuant to

4 JCRCP 5(b), by depositing a copy of the same in the United States Mail in Las Vegas, Nevada,
postage prepaid, addressed as follows (insert name and address of the opposing party’s attorney,
5
or opposing party if unrepresented):
6

10
Per NRS 53.045, “I declare under penalty of perjury that the foregoing is true and
11
correct.”
12

13
(Date) (Type or print name) (Signature)
14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

© Civil Law Self-Help Center Page 3

Clark County, Nevada