ORDER FOR PROTECTION RETURN OF SERVICE
Case No. _________ Dept. No. _________
__________________________________________________, (Name) Applicant, VS. __________________________________________________, (Name) Adverse Party.
IN THE JUSTICE COURT OF __________TOWNSHIP COUNTY OF ___________, STATE OF NEVADA
OR
IN THE ______________ JUDICIAL DISTRICT COURT OF THE STATE OF NEVADA, IN AND FOR THE COUNTY OF ______________________
TYPE OF ORDER SERVED
I HEREBY CERTIFY THAT ON ________________________________ I RECEIVED: (DATE) Emergency Temporary Order for Protection Temporary Order for Protection Extended Order for Protection Notice for Hearing to Extend, Modify or Dissolve the Order for Protection Order for Hearing to Extend, Modify or Dissolve the Order for Protection Foreign Order (describe in terms of State/County/City & Court Issued from) Temporary Stalking/Harassment Order Extended Stalking/Harassment Order Motion/Notice of Hearing
Other (describe): __________________________________________________________________________________________
I FURTHER CERTIFY THAT I: PERSONALLY SERVED the same upon the Adverse Party/Applicant, _________________________________________, (Name) on ______________________, at _____________ , who identified him/herself by or with, (Date) (Time) ____________________________________, at (location): _____________________________________________________, (Type of Identification) City of ________________________________________, County of _________________________, State of Nevada. ATTEMPTED TO SERVE same on: _______________________________, __________________________________, and ____________________________. The Adverse Party/Applicant was not found and service was NOT effected. INFORMED THE ADVERSE PARTY of the specific terms and conditions of the order and that a violation of the order will result in his/her arrest and the location of the court that issued the order and the hours during which he/she may obtain a copy of the order. SIGNATURE (Officer/Person Serving Order/ID Number)
Print Name (Officer/Person Serving Order)
Print Address (Officer/Person Serving Order)
SIGNATURE (Adverse Party/Witness, if applicable)
Print Name and Address
COURT DISTRIBUTION:
WHITE ♦ COURT
YELLOW ♦ LAW ENFORCEMENT
PINK ♦ APPLICANT
GOLD ♦ REPOSITORY