[SELECT FROM DROP-DOWN]

1 JUSTICE COURT, TOWNSHIP OF

CLARK COUNTY, NEVADA
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Landlord's
3 Name: [TYPE YOUR LANDLORD'S FULL NAME HERE] Case No.: [TYPE CASE NO. HERE]
Landlord,
4 Dept No.: [TYPE DEPT. NO. HERE]

vs.
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Tenant's
6 Name: [TYPE YOUR FULL NAME HERE]

Address: [TYPE YOUR STREET ADDRESS AND UNIT # HERE]

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City,State,Zip: [TYPE YOUR CITY, STATE, AND ZIP CODE HERE]
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Phone: [TYPE YOUR AREA CODE AND PHONE NUMBER HERE] MOTION FOR EXPEDITED RELIEF
9 FOR THE UNLAWFUL REMOVAL OR
E-Mail: [TYPE YOUR E-MAIL ADDRESS HERE] EXCLUSION OF TENANT OR
10 INTERRUPTION OF ESSENTIAL
Tenant.
ITEMS OR SERVICES
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Tenant, appearing in proper person, files this motion against Landlord pursuant to NRS 118A.390(5)(b) and
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alleges as follows:
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1. My Landlord HAS instituted a pending court case for summary eviction or a pending court case for unlawful
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detainer against me. (If your Landlord HAS NOT filed an eviction case against you, you CANNOT use
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this form. You must file a Verified Complaint for Expedited Relief.)
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2. I am filing this motion within 5 judicial days of Landlord's unlawful act. Specifically, my Landlord (check
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applicable box(es) and insert date):
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Removed me from the premises or my dwelling unit on or about (insert date) [TYPE DATE OR N/A]
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Excluded me from the premises or my dwelling unit by blocking or attempting to block my entry on or
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about (insert date) [TYPE DATE OR N/A] .
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Terminated my utilities or other essential item or service on or about (insert date) [TYPE DATE OR N/A]
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(If the power/gas/water company terminated your utilities for unpaid bills, you will not be entitled to
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relief from the Court.)
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Recovered possession of the premises or dwelling unit on or about (insert date) [TYPE DATE OR N/A]
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in violation of NRS 118A.480, which prohibits a landlord from recovering possession by any means other
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than through a court action, upon a tenant's surrender of the dwelling unit, or when a tenant abandons the
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dwelling unit per NRS 118A.450.
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© 2014 Page 1 of 5 MOTION FOR ILLEGAL LOCKOUT OR TERMINATION OF SERVICES
Clark County, Nevada
(Rev. 2.4, 06-20-2014)

For forms and information, visit www.CivilLawSelfHelpCenter.org

 1 3. I entered into a rental agreement with Landlord on or about (insert date of rental agreement):

2 [TYPE DATE HERE] .

3 4. The address of the dwelling unit I rented from Landlord is (insert address, including city, state, and zip):

4 [TYPE COMPLETE ADDRESS OF RENTAL UNIT HERE, WITH UNIT NUMBER, CITY, STATE, AND ZIP] .

5 5. The rental agreement (check one) was in writing/ was not in writing. (If agreement was in writing,

6 attach copy if one is available.)

7 6. The amount of rent I pay is (insert amount) $ [TYPE AMOUNT OR N/A] .

8 7. I pay my rent (check one box) weekly/ monthly/ or other

9 (explain):

10 [EXPLAIN YOUR RENT PAYMENT SCHEDULE HERE, OR TYPE N/A] .

11 8. My rent (check one box) is current/ is not current, and I now owe back rent in the amount of (insert
12 amount of back rent owed) $ [TYPE AMOUNT OR N/A] .
13 9. My next rental payment is due on (insert date) [TYPE DATE HERE] .
14 10. The factual circumstances surrounding the blocked entry and/or termination of essential items or services are
15 as follows (explain): (For example, if you were barred from entry, please describe how it was done. If your
16 utilities were terminated, please state which utilities were affected.)
17 [TYPE YOUR DESCRIPTION OF HOW LOCKOUT OR SERVICE TERMINATION HAPPENED ON THESE LINES]

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      Check if attaching continuation
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11. My Landlord (check applicable box(es) and, if available, attach all letters sent to or from Landlord that
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© 2014 Page 2 of 5 MOTION FOR ILLEGAL LOCKOUT OR TERMINATION OF SERVICES
Clark County, Nevada
(Rev. 2.4, 06-20-2014)

For forms and information, visit www.CivilLawSelfHelpCenter.org

 1 evidence your requests or Landlord’s refusal):

2 Refused to let me back into the premises or dwelling unit after Landlord removed me from or blocked my

3 entry into the premises or dwelling unit, despite my requests for entry.

4 Refused to restore my services or items after Landlord terminated my utilities or other essential items or

5 services, despite my requests to have them restored.

6 12. In addition to statutory damages of $2,500.00, I am seeking compensation for the following items of actual

7 damage I incurred as allowed under NRS 118A.390(1) (insert amount and description):

8 $ [TYPE AMOUNT] for [TYPE DESCRIPTION OF WHAT MONEY WAS SPENT FOR, OR TYPE N/A] .

9 $       for       .

10 $       for       .

11 $       for       .

12 $       for       .

13 Based upon the above, Tenant requests that this Court:

14 (a) Find that Landlord has violated NRS 118A.390;

15 (b) Assess actual and statutory damages against Landlord not to exceed the jurisdictional limit;

16 (c) Issue an immediate order restoring me to the premises and/or restoring the utilities or essential items or

17 services; and

18 (d) Enjoin Landlord for violating the provisions of NRS 118A.390 and, if the circumstances so warrant,

19 hold Landlord in contempt.

20 I declare under penalty of perjury under the law of the State of Nevada that the foregoing is true and correct.
[SIGN HERE AFTER YOU PRINT, OR
21 [TYPE DATE YOU ARE ATTACH ELECTRONIC SIGNATURE IF
SIGNING] [TYPE YOUR FULL NAME HERE] ALLOWED BY COURT RULES]
(Date) (Type or print name) (Signature)
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VERIFICATION
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Under penalties of perjury, I declare that I am the Defendant/Tenant named in the foregoing Motion for
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Expedited Relief for the Unlawful Removal or Exclusion of Tenant or for the Willful Interruption of Essential Items
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or Services and know the contents thereof; that the motion is true of my own knowledge, except as to those matters
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stated on information and belief, and that as to such matters I believe them to be true.
27 I declare under penalty of perjury under the law of the State of Nevada that the foregoing is true and correct.
[TYPE DATE YOU ARE [TYPE YOUR FULL NAME HERE] [SIGN HERE AFTER YOU PRINT, OR
28 SIGNING] ATTACH ELECTRONIC SIGNATURE IF

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© 2014 Page 3 of 5 MOTION FOR ILLEGAL LOCKOUT OR TERMINATION OF SERVICES
Clark County, Nevada
(Rev. 2.4, 06-20-2014)

For forms and information, visit www.CivilLawSelfHelpCenter.org

 ALLOWED BY COURT RULES]
1 (Date) (Type or print name) (Signature)

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Clark County, Nevada
(Rev. 2.4, 06-20-2014)

For forms and information, visit www.CivilLawSelfHelpCenter.org

 1 (The following section is to be completed by the Court Clerk only.)

NOTICE OF HEARING
2
TO: LANDLORD
3
PLEASE TAKE NOTICE THAT the Motion for the Unlawful Removal or Exclusion of Tenant or for the
4 Willful Interruption of Essential Items or Services filed in this case shall be, and hereby is:
5  Set to be heard on the ______ day of _________________________, 20______, at the hour of

6 ___________ ___.M., in Department No. ______, at the Justice Court located at:

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This hearing date is not later than 3 judicial days after the filing of the motion in accordance with NRS
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118A.390(6).
9  Other:
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You are required to appear at the hearing and bring with you all books, papers, and witnesses needed to
12 establish your defense to Tenant's motion. Your failure to appear at the hearing may result in the requested relief
being granted by the Court in your absence. You do not need to appear if you do not wish to contest the motion.
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Tenant shall cause a copy of this Notice of Hearing and the related Motion for Expedited Relief to be
served upon Landlord pursuant to JCRCP 5(b)(2)(A) by (i) handing it to the Landlord, (ii) leaving it at the
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Landlord's office with a clerk or other person in charge, or if there is no one in charge, leaving it in a conspicuous
place in the office, or (iii) if the office is closed or the Landlord has no office, leaving it at the Landlord's dwelling
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house or usual place of abode with some person of suitable age and discretion residing therein. Before or at the
scheduled hearing, Tenant must provide proof that Landlord has been properly served.
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DATED: ____________________ __________________________________________________
18 CLERK OF THE COURT

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NOTE: Tenant must arrange for service on Landlord as required above. Person performing service on Landlord
20 must complete Affidavit below. Tenant must file completed Affidavit with Court prior to or at scheduled hearing.
AFFIDAVIT OF SERVICE
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I, (insert name of person performing service) ____________________________________________________,
22 declare under penalty of perjury that on (insert date service was made) ______________________________, 20____, I
served (insert name of person served) ____________________________________________________ with a true and
23 correct copy of Tenant's Motion for Expedited Relief, including the above Notice of Hearing, at ( insert address where
service was made) _____________________________________________________________________________,
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which constitutes (check one of the following):  handing it to the Landlord,  leaving it at the Landlord's office with
25 a clerk or other person in charge, or if there is no one in charge, leaving it in a conspicuous place in the office, or 
if the office is closed or the Landlord has no office, leaving it at the Landlord's dwelling house or usual place of
26 abode with some person of suitable age and discretion residing therein.

27 I declare under penalty of perjury under the law of the State of Nevada that the foregoing is true and correct.

28 (Date) (Type or print name) (Signature)

28Civil Law Self-Help Center

© 2014 Page 5 of 5 MOTION FOR ILLEGAL LOCKOUT OR TERMINATION OF SERVICES
Clark County, Nevada
(Rev. 2.4, 06-20-2014)

For forms and information, visit www.CivilLawSelfHelpCenter.org