Nev. Rev. Stat. § 118A.347
An affidavit submitted by a tenant or cotenant pursuant to subsection 2 of NRS 118A.345 must be in substantially the following form:
(Name of the qualified third party, as defined in NRS 118A.345, including, if applicable, the name of the organization with which the qualified third party is affiliated)
I (and/or) ..................................................................................................................
(name of cotenant or household member)
am a victim of domestic violence as defined in NRS 118A.345.
Brief description of incident(s) constituting domestic violence:
The incident(s) that I described above occurred on the following date(s) and time(s), and in the following locations:
The incident(s) that I described above were committed by the following person(s):
I state under penalty of perjury under the laws of the State of Nevada that the foregoing is true and correct.
Dated this ....... day of ..............., 20....., at .................... (city), Nevada,
(Signature of tenant, cotenant
or household member)
I verify that the person whose signature appears above was a victim of domestic violence and that the person informed me of the name of the adverse party as defined in NRS 118A.345.
Dated this ....... day of ..............., 20....., at .................... (city), Nevada,
(Signature of qualified third party)
NRS 118A.347