Instructions – NRS 250 Confidential Information Packet
This packet is used for the following:
• Any Peace Officer as defined by NRS 250.140(2)
• Any Prosecutor or Public Defender (for Prosecutors and Public Defenders who as part of
his or her normal responsibilities prosecutes/defends persons for crimes that are
punishable as Category A felonies or domestic violence please use the SB 79 packet).
• The spouse, domestic partner or minor child of any of the persons described above.
• The surviving spouse, domestic partner or minor child of any of the persons described
above who was killed in the performance of his or her duties.
Please follow the below instructions to apply for a court order to restrict public access to your
home address pursuant to NRS 250 (County Assessor).
1. Fill out the attached Affidavit cover sheet, Affidavit, and proposed Order.
1. Submit the completed original documents to the Chief Judge Chambers located on the
10
th
Floor of the RJC or by mail to:
Chief Judge of the Eighth Judicial District Court
Regional Justice Center
200 Lewis Avenue, 10
th
Floor
Las Vegas, NV 89155
**Please include a business card with a telephone number.
2. If approved, you will be notified when your signed certified Order is ready for pick up.
3. You are responsible for sending a copy of the Affidavit and signed certified Order to the
County Assessor.
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AFFT
Name:
Address:
Telephone:
Fax Number:
Email Address:
DISTRICT COURT
CLARK COUNTY, NEVADA
In Re: Matter of the filing of
Affidavits / Orders Pursuant to
(NRS 250)
CASE NO. ________
_____
DEPT NO. ___
AFFIDAVIT OF __________________________
REQUESTING CONFIDENTIALITY PURSUANT TO NRS 250
Your Name
Address Line 2
Address
Telephone Number
Fax Number
Email Address
Your Name
Department Use Only
AFFIDAVIT OF _____________________________ REQUESTING
(Your Name Here)
CONFIDENTIALITY PURSUANT TO NRS 250.100, et seq.
STATE OF NEVADA
)
) ss.
COUNTY OF CLARK )
I, ______________________________, being duly sworn, depose and say:
1. That I qualify to have personal information that is contained in the records of the
County Assessor be kept confidential pursuant to NRS 250.140, as:
(Check Only One Box)
□ (a) A peace officer or retired peace officer, working as ___________________________
(Specify Job Title)
with the following state or federal agency ___________________________________________,
(Specify Employer)
pursuant to NRS _____________________________________________________________.
(if state agency, specify applicable peace officer statute within NRS 289.150 to 289.360)
□ (b) Any Prosecutor.
□ (c) Any State or County Public Defender.
□ (d) The spouse, domestic partner or minor child of __________________________.
(Specify Applicable Name and Job Title)
□ (e) The surviving spouse, domestic partner or minor child of _____________________
(Specify Applicable Name and Job Title)
who was killed in the performance of his or her duties.
2. That as a result of the information contained above, there is or has been contact with
individuals who are suspected of crimes, have been convicted of crimes and are on
probation/parole for crimes.
3. That as a result, there is exposure to possible retribution, retaliation, threats,
harassment or violence by these negatively affected individuals or their associates.
4. That this exposure creates a special risk of harm at my home.
Your Name
Your Name
5. That for my protection, it is necessary to keep confidential my home address, phone
number, and electronic email address.
6. (Optional additional space for further justification)
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
7. That the name for which this confidentiality shall attach is:
______________________________________________________________________________
______________________________________________________________________________
8. That the home address(es), and parcel number(s) or personal property number(s)
(parcel number or personal property number is required) of the person for which this
confidentiality shall attach are:
______________________________________________________________________________
(Specify Address)
______________________________________________________________________________
(Specify Parcel Number Or Personal Property Number)
______________________________________________________________________________
(Specify Telephone Number(s))
______________________________________________________________________________
(Specify Electronic Mail Address(es)
_
_____________________________________
Signed
Subscribed and sworn to before me this
_____ day of ________________, 20___
_______________________________
NOTARY PUBLIC in and for said
County and State
Rev 12/2017
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ORDR
Name:
Address:
Telephone:
Fax Number:
Email Address:
DISTRICT COURT
CLARK COUNTY, NEVADA
In Re: Matter of the filing of
Affidavits / Orders Pursuant to
(NRS 250)
CASE NO. _____________
DEPT
NO. ___
ORDER
This matter having been reviewed in chambers on the __ day of _____________,
20__, upon the Affidavit Requesting Confidentiality Pursuant to NRS 250, incorporated
by reference, and the court having considered the same, and good cause appearing
therefor, IT IS HEREBY ORDERED, ADJUDGED AND DECREED that pursuant to
NRS 250, subject to the exceptions delineated in state law, the County Assessor shall
keep confidential and shall not disclose the personal information (phone number(s),
electronic mail address(es), and home address(es)) of the following person:
IT IS FURTHER ORDERED, ADJUDGED AND DECREED that this Order
shall remain in effect until further order of this Court, the real property is sold or
conveyed or if the person signs a consent with the Assessor’s Office to disclose
confidential information pursuant to NRS 250 by providing a written sworn statement
made under oath to the County Assessor, indicating the manner of said disclosure;
Your Name
Address
Address Line 2
Telephone Number
Fax Number
Email Address
Dept.
Dept.
Department Use Only
Department Use Only
Dept.
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IT IS FURTHER ORDERED, ADJUDGED AND DECREED that upon
evidence sufficient to the County Assessor that the real and/or personal property
subject to this Order has been conveyed from the person herein named in this Order,
the County Assessor may without further order of this Court terminate the non-
disclosure of confidential information as delineated herein.
IT IS FURTHER ORDERED, ADJUDGED AND DECREED that this Order
shall be
sealed and access will not be allowed to anyone without a court order.
DATED ________________
District Court Chief Judge
Department Use Only
Department Use Only