social security numbers, gender, and birth date(s) :5 … · social security, gender, birth date dc...
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![Page 1: SOCIAL SECURITY NUMBERS, GENDER, AND BIRTH DATE(S) :5 … · Social Security, Gender, Birth Date DC 6:5.12 Rev. 06/19 PSC Nebraska o/b/o OR Additional Petitioner/Minor Child(ren)](https://reader033.vdocument.in/reader033/viewer/2022053022/604b92a5e1205a67053e1fbb/html5/thumbnails/1.jpg)
(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
Case No. CI ____________ (case number assigned by Clerk of Court)
SOCIAL SECURITY NUMBERS, GENDER, AND BIRTH DATE(S)
vs.
________________________________________, (name of person listed as defendant/respondent in original action)
Defendant/Respondent.
Names Social Security Number Gender Date of Birth
Plaintiff /Petitioner:
__________________ ____________________ _______ _____________
Defendant/Respondent:
____________________ _______ _____________ ___________________
Additional Petitioner(s)/Minor Children:
___________________ ____________________ _______ _____________
___________________ ____________________ _______ _____________
___________________ ____________________ _______ _____________
___________________ ____________________ _______ _____________
___________________ ____________________ _______ _____________
Nebraska State Court Form
DC 6:5.12 Rev. 06/19 Neb. Ct. R. § 6-1521
SOCIAL SECURITY NUMBERS, GENDER, AND BIRTH DATE(S)
(For other information, add pages as required.)
Page 1 of 1Social Security, Gender, Birth Date DC 6:5.12 Rev. 06/19PSC Nebraska
o/b/o OR Additional Petitioner/Minor Child(ren) ,
Additional Petitioner/Minor Child(ren),
________________________________________, (name of person listed as plaintiff/petitioner in original action)
Plaintiff/Petitioner, If you are filing for a protection order, fill in the next two lines the same way that they are listed on the petition