STATE OF NEBRASKA FORM NO. DC 19-14 Rev. 7/06
Neb. Rev. Stat. ยง 42-924 - 28-311.09
REQUEST FOR HEARING
CASE NUMBER: DOCUMENT No.:
IN THE DISTRICT COURT OF
COUNTY, NEBRASKA
REQUEST FOR HEARING
Petitioner
vs.
Respondent On , I was served with a protection order in this case. I wish to appear and show cause why the order should not remain in effect, and request a hearing for that purpose. I understand that notice of the time and place of hearing shall be mailed to the address set forth below. I ( do do not) speak English. My language is .
Date:
, (Signature)
Mailing Address: City, State, Zip Code: Telephone: (Home) (Employment)
RETURN TO: Clerk of the District Court (Address:)