Nev. Admin. Code § 50.065
A declaration referred to in subsection 5 of NRS 50.315 must be in substantially the following form:
I, ................., hereby declare:
That I am a ................ (occupation) employed by ................ (employer);
That on ......................... (date) I received from ........ (name of person) certain evidence bearing Identification No. ..... of the ............. (law enforcement agency), consisting of ............... (description of evidence); and
That I kept the evidence in my sole custody or control and in substantially the same condition as when I first received it until on ......................... (date) when I delivered the evidence to ............... (name of person).
I declare under penalty of perjury that the foregoing is true and correct.
Executed on ......................................... .............................................................................
(Date) (Declarant's Signature)
.............................................................................
(Declarant's Title)
Nev. Admin. Code § 50.065
NRS 50.315