CONFIDENTIAL PROTECTION ORDER INFORMATION
JUSTICE COURT, LAS VEGAS TOWNSHIP
CLARK COUNTY, NEVADA
Name: ) CASE NO.:
) DEPT. NO.:
Applicant(s), )
)
-vs- )
)
Name: )
) CONFIDENTIAL PROTECTION ORDER
Adverse Party(s). ) INFORMATION SHEET
APPLICANT INFORMATION
1. Name:
(Last) (First) (Middle)
2. Other Names Used:
(Last) (First) (Middle)
3. Phone:
(Home) (Work) (Cell)
4. Home Address: (Street Address ) (Bldg/Apt #) (City) (State) (Zip)
5. Mailing Address:
(If different from above) (Street Address ) (Bldg/Apt #) (City) (State) (Zip)
6. Date of Birth: / / 7. Sex:
ADVERSE PARTY INFORMATION
(Please complete a separate Confidential Protection Order Information Sheet for each Adverse Party)
1. Name:
(Last) (First) (Middle)
2. Other Names Used:
(Last) (First) (Middle)
3. Phone:
(Home) (Work) (Cell)
4. Last Known Address: (Street Address ) (Bldg/Apt #) (City) (State) (Zip)
5. Mailing Address:
(If different from above) (Street Address ) (Bldg/Apt #) (City) (State) (Zip)
6. Occupation: Employer: Work Days: __________ Work Hours:
Work Phone: Work Address:
7. Date of Birth: / / 8. Social Security No.: - -
9. Hair Color: 10. Eye Color: 11. Height: 12. Weight: 13. Sex: 14. Race:
15. Scars/Marks/Tattoos (Provide a Description and Location):
16. Does the Adverse Party speak English? ο YES ο NO If not, what language?
17. Vehicle Make: ________ Model: ________ Year: ________ License Plate Number/State:
(Date) (Type Or Print Name) (Signature)
LVJCVL-52 Revised 7-11
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