Fill and Sign the In the Supreme Court of the State of Nevada No 74071 Filed Form

Form F 6/10/05 1 IN THE SUPREME COURT OF THE STATE OF NEVADA _____________ _______________ __________, Appellant, vs. _____________ _______________ __________, Respondent. Supreme Court No . ______________ District Court No. _______________ MOTION FOR STAY FORM FOR PARTIES WITH OUT ATTORNEYS INSTRUCTIONS : Write only in the space allowed on the form. Additional pages and attachment s are not permitted. The Nevada Supreme Court prefers short and direct statements. Cita tion to legal authority or the district court record is not re quired but would be he lpful to the Court. Any form you file with the Nevada Supreme Court must be mailed or delivered to all other part ies to this appeal or to the parties’ attorneys. You may file your forms in person or by mail. You must file the original and 2 copies with the Clerk of the Nevada Supreme Court. If you want the clerk to return a file-stamped copy of your form, you mu st submit the original and 3 copies and include a self-addressed, stamped envelope. Documents cannot be faxed or e-mailed to the Clerk’s Office. This form must be filed wi th the Clerk of the Nevada Supreme Court at the following address: Clerk of the Court Supreme Court of Nevada 201 South Carson Street Carson City, Nevada 89701 Telephone: (775) 684-1600 or (702) 486-9300 Form F 6/10/05 2 Judgment or Order You Are Appealing. Specify the judgment or order that you are appealing fr om and the date that the judgment or order was filed in the district court. Filed Date Name of Judgment or Order Notice of Appeal. Specify the date you filed yo ur notice of appeal in the district court:_______ __________________________ Order to be Stayed. A stay from the Nevada Supreme Court prevents enforcement of a district court or der. What do you want stayed? ___________________ ____________________________________ _________________ ___________________ ____________________________________ _________________ ___________________ _______________________________________ _____________. Statement of Facts. Briefly explain the facts re lated to your request for a stay. (Your answer must be pr ovided in the space allowed.) ___________________ ____________________________________ _________________ ___________________ ____________________________________ _________________ ___________________ ____________________________________ _________________ ___________________ ____________________________________ _________________ ___________________ ____________________________________ _________________ ___________________ ____________________________________ _________________ ___________________ ____________________________________ _________________ ___________________ ____________________________________ _________________ ___________________ ____________________________________ _________________ ___________________ ____________________________________ _________________ ___________________ ____________________________________ _________________ ___________________ ____________________________________ _________________ Form F 6/10/05 3 ___________________ ____________________________________ _________________ ___________________ ____________________________________ _________________ ___________________ ____________________________________ _________________ ___________________ ____________________________________ _________________ ___________________ ____________________________________ _________________ ___________________ ____________________________________ _________________ ___________________ ____________________________________ _________________ ___________________ ____________________________________ _________________ ___________________ ____________________________________ _________________ ___________________ ____________________________________ _________________ ___________________ ____________________________________ _________________ ___________________ ____________________________________ _________________ ___________________ ____________________________________ _________________ ___________________ ____________________________________ _________________ ___________________ ____________________________________ _________________ ___________________ ____________________________________ _________________ ___________________ ____________________________________ _________________ ___________________ ____________________________________ _________________ ___________________ ____________________________________ _________________ ___________________ ____________________________________ _________________ ___________________ ____________________________________ _________________ ___________________ _____________________________________________________ Effect on Your Appeal. If a stay is denied, how will this affect the issues you are appealing? (Your answer must be provided in the space allowed.) ___________________ ____________________________________ _________________ ___________________ ____________________________________ _________________ ___________________ ____________________________________ _________________ Form F 6/10/05 4 ___________________ ____________________________________ _________________ ___________________ ____________________________________ _________________ ___________________ _____________________________________________________ Harm to You. What serious harm will you experience if a stay is denied? (Your answer must be provid ed in the space allowed.) ___________________ ____________________________________ _________________ ___________________ ____________________________________ _________________ ___________________ ____________________________________ _________________ ___________________ ____________________________________ _________________ ___________________ _____________________________________________________ Harm to Others. What harm will the other si de experience if the stay is granted? (Your answer must be provided in the space allowed.) ___________________ ____________________________________ _________________ ___________________ ____________________________________ _________________ ___________________ ____________________________________ _________________ ___________________ ____________________________________ _________________ ___________________ _____________________________________________________ Success on Appeal. Why are you likely to win this appeal? (Your answer must be provided in the space allowed.) ___________________ ____________________________________ _________________ ___________________ ____________________________________ _________________ ___________________ ____________________________________ _________________ ___________________ ____________________________________ _________________ ___________________ ____________________________________ _________________ ___________________ ____________________________________ _________________ ___________________ ____________________________________ _________________ ___________________ _______________________________________ _____________. Form F 6/10/05 5 CERTIFICATE OF SERVICE I certify that on the date indicate d below, I served a copy of this completed appeal statement upon all parties to the appeal as follows: By personally serving it upon him/her; or By mailing it by fi rst class mail with suffici ent postage prepaid to the following addresss(es): DATED this _____ day of _______________________, 20___. _____________ _____________ Signature of Moving Party _____________ _____________ Print Name of Moving Party _____________ _____________ Address _____________ _____________ City/State/Zip _____________ _____________ Telephone