JCRLV 51

In an action arising under NRS Chapter 604A, the plaintiff must file a “Defaulted Loan Information Sheet,” which must include information in the following format:

DEFAULTED LOAN INFORMATION SHEET

(To be completed by the lender at the time of filing the Complaint)

Name of lender:____________________________________________________

Name of the borrower:_______________________________________________

Date of loan:____________________ Principal amount: $___________________

Annual percentage rate:____________ Total finance charges: $_______________

Other fees (please specify): $__________________________________________

Total payment amount: $_____________________________________________

Date loan due:___________________ Date of default:______________________

Date repayment plan sent to borrower:___________________________________

Expiration date of offer:______________________________________________

Interest rate calculation: In order to determine the final judgment amount, the Court needs to determine the method by which you calculated the total interest due.

Original loan amount: $______________________________________________

Interest accrued at original rate before default: $____________________________

Interest accrued at the statutory rate following default (for no more than 90 days): $_

Any authorized fees: $_____________ Total claimed amount: $_______________

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

Signature_______________________ Executed on ________________________