Nev. Rev. Stat. ch. 118A § 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)