Free IN THE DISTRICT COURT OF ___________________ COUNTY, NEBRASKA - Nebraska

IN THE DISTRICT COURT OF ___________________ COUNTY, NEBRASKA
(county where original action was filed)

THIS DOCUMENT IS CONFIDENTIAL AND SHALL NOT BE MADE PART OF THE CASE FILE OR PROVIDED TO THE PUBLIC

________________________________,
(name of person listed as plaintiff/petitioner in original action)

Plaintiff/Petitioner, vs. ________________________________,
(name of person listed as defendant/respondent in original action)

Case No. CI ____________
(case number assigned by Clerk of Court)

SOCIAL SECURITY NUMBERS, GENDER, AND BIRTH DATE(S)

Defendant/Respondent.

Names Plaintiff /Petitioner: __________________ Defendant/Respondent: ___________________ Minor Children: ___________________ ___________________ ___________________ ___________________ ___________________

Social Security Number

Gender

Date of Birth

____________________

_______

_____________

____________________

_______

_____________

____________________ ____________________ ____________________ ____________________ ____________________

_______ _______ _______ _______ _______

_____________ _____________ _____________ _____________ _____________

(For other information, add pages as required.)
Social Security, Gender, Birth Date, DC 6:5(12) Adopted 12/17/2008 § 6-1701