Nevada Administrative Code
Chapter 50 - Witnesses
Section 50.020 - Form of affidavit regarding competence of person to operate certified breath-testing device and regarding identity of person from whom affiant obtained sample

An affidavit which is referred to in subsection 1 of NRS 50.315 must be in substantially the following form:

State of Nevada }

}ss.

County of............................... }

I, .............................., being first duly sworn, depose and say:

That I am ................ (occupation) employed by ............. (employer);

That I was certified on ......................... (date) by the Director of the Department of Public Safety as being competent to operate a ................ (name of breath-testing device), a device of a type which, as designed and manufactured, has been certified by the Committee on Testing for Intoxication to be accurate and reliable for testing a person's breath to determine the concentration of alcohol in his or her breath;

That on ......................... (date) I obtained a sample of the breath of ................ (name of person tested) and tested it in accordance with the prescribed checklist on a ................ (name of device) which was functioning properly; and

That the tests indicated the breath of the person tested contained the following concentrations of alcohol (grams per 210 liters of breath):

1st test .... 2nd test .... 3rd test ....

...........................................................

Affiant's Signature

...........................................................

Affiant's Title

Subscribed and sworn to before me this

............. day of the month of ........... of the year ......

...................................................................................

Notary Public

Added to NAC by Com. on Testing for Intoxication, eff. 10-26-83; A 11-23-93; 9-9-94; R112-97, 5-26-98; R137-99, 12-13-99

NRS 50.315