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

PUBLIC PURSUANT TO NEB. CT. R. § 6-1521.

IN RE NAME CHANGE OF CASE No.___________________ (case number assigned by clerk of court)

_____________________. (your full name)

CONFIDENTIAL PARTY INFORMATION -

ADULT NAME CHANGE

Name Birth Date

Petitioner:

(your current full name)

Page 1 of 1Confidential Party Information - Adult Name ChangeDC 6:9.4 NEW 01/2020

Nebraska State Court Form

DC 6:9.4 NEW 01/2020

CONFIDENTIAL PARTY INFORMATION -

ADULT NAME CHANGE

(county where Petition filed)