STATE OF NEBRASKA FORM NO. Appendix 5 Rev. 2/09 Chapter 2, Article 1
CERTIFICATE OF CIVIL APPEAL
CASE NUMBER:
_____________________
IN THE DISTRICT COURT OF
COUNTY, NEBRASKA
Plaintiff vs.
Attorney: Address: Telephone: Attorney: Address: Telephone:
No.
Defendant
No.
I certify that the attached are true and accurate copies of pleadings filed in the above-captioned civil case. Type of case: Law (general) Dissolution Paternity Juvenile Adjudication Termination Criminal
Origin of case: County Court District Court Other Notice of appeal directed to: Court of Appeals Supreme Court Statutory authority: Constitutionality of statute Other (specify statute) __________________ . ; or . or .
OR
Notice of appeal filed on Statutory docket fee paid on poverty affidavit filed on
posted on Cost bond in the amount of $ posted on Cash in lieu of cost bond in the amount of $ posted on supersedeas bond in the amount of $
The following motions have been filed: Date disposed of: Motion for new trial. Date filed: Date disposed of: Motion to alter or amend judgment. Date filed: Date disposed of: Motion to set aside verdict or judgment. Date filed: Date filed: None of the above motions have been filed. Date: (SEAL) Clerk of District Court By: