Attorney’s Name - Eighth Judicial District Court



ABREA

Attorney’s Name

Attorney’s Bar Number

Attorney’s Firm Name

Attorney’s Address

Attorney’s Phone Number

Party Attorney Represents

DISTRICT COURT

CLARK COUNTY, NEVADA

)

)

)

Plaintiff, )

)

v. ) CASE NO. A-

) DEPT NO.

)

Defendants. )

__________________________________________)

REQUEST FOR EXEMPTION FROM ARBITRATION

(Plaintiff/Defendant) hereby requests the above entitled matter be exempted from The Court Annexed Arbitration Program pursuant to Nevada Arbitration Rule 5. This matter qualifies for a permissive exemption (NAR 5(b)) as follows:

|□ case presents significant issues of public policy |

|□ case presents unusual circumstances that constitute good cause |

|□ case involves an amount in excess of $50,000 per Plaintiff, exclusive of interest and costs |

A specific summary of the facts which supports my contention for exemption is as follows: [Please include nature of case; a listing of the total amount of damages sought; if a personal injury case, include the diagnosis of injuries sustained, the total amount of medicals to date (listed by provider with dates of treatment) with references to statements of any key medical providers (may attach copies of key medical records that have had personal identifying information redacted). If claiming future medical treatment, include information regarding the date of the recommendation (attaching a copy, redacting any

ARB FORM 7 (1 of 3)

personal identifying information) for the future treatment and any proof of a cost estimate

(NAR 5(b)(2) “the request for exemption must also include a summary of facts, including any evidentiary support necessary to illustrate the party’s contentions.” If causation is disputed, include necessary expert conclusion.] .

OR:

Plaintiff failed to properly seek an automatic exemption in the caption of the Complaint, pursuant to NAR 5. Plaintiff hereby requests the above entitled matter be exempted from The Court Annexed Arbitration Program pursuant to Nevada Arbitration Rule 5. The matter qualifies for an automatic exemption as follows:

|Automatic Exemption (NAR 5(a)(1)): | |

|□ class action | |

|□ appeal from court of limited jurisdiction | |

|□ action concerning title to real estate | |

|□ action for declaratory relief | |

|□ action for medical or dental malpractice | |

|□ action for equitable or extraordinary relief | |

|□ business court action | |

|□ construction defect action | |

|□ action in which any of the parties is incarcerated | |

I hereby certify pursuant to NRCP 11 this case is included within the exemption(s) marked above and am aware of the sanctions that may be imposed against any attorney or party who without good cause or justification attempts to remove a case from the arbitration program.

ARB FORM 7 (2 of 3)

I further certify pursuant to NRS Chapter 239B and NRS 603A.040 that this document and any attachments thereto do not contain personal information including, without limitation, home address/phone number, social security number, driver’s license

number or identification card number, account number, PIN numbers, credit card number or debit card number, in combination with any required security code, access code or password that would permit access to the person’s financial account.

DATED this day of , 20__.

ATTORNEY

BAR NUMBER

ADDRESS

PARTY

CERTIFICATE OF SERVICE

I hereby certify that on the day of , 20__, I mailed a copy of the foregoing REQUEST FOR EXEMPTION FROM ARBITRATION in a sealed envelope to the following counsel of record and that postage was fully prepaid thereon OR this document was served via E-Service:

EMPLOYEE OF ATTORNEY

NOTE: REQUEST FOR EXEMPTION TO BE SERVED ON ANY PARTY WHO HAS APPEARED

IN THE ACTION.

NOTE: THE ADR COMMISSIONER WILL CONSIDER ANY WRITTEN OPPOSITION TO REQUEST, IF FILED WITHIN SEVEN (7) DAYS OF SERVICE OF THE REQUEST; SAID OPPOSITION MUST BE SERVED ON ALL APPEARING PARTIES AND FILED WITH THE CLERK OF COURT IN A TIMELY FASHION TO BE CONSIDERED.

ARB FORM 7 (3 of 3)

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