STATE OF NEBRASKA FORM NO. DC 19-1 Rev. 6/08. Neb. Rev. Stat. § 42-924 28-311.09. REQUIRED CASE NUMBER: PROTECTION ORDER PRAECIPE DOUGLAS DOCUMENT NO.: IN THE DISTRICT COURT OF COUNTY, NEBRASKA Petitioner vs. Respondent TO THE CLERK OF COURT: Please have the Sheriff of one of the following addresses: Home: Work: Other locations where respondent can be found: Directions for Service: PRAECIPE County serve a certified copy of the protection order and/or order to show cause, petition, and request for hearing (if applicable) upon the respondent by personal service at any Petitioner Address Telephone (If you are concealing your address or phone, do not provide them. Make separate arrangements with the clerk.) Fill in any of the following information if known. Description of Respondent: Alias: Sex: Eye Color: Skin Tone: Employer: Age: Height: Hair Color: Place of Birth: Work Days and Hours: Weight: Race: Describe Scars, Marks, Beards, Tattoos, etc.: DC 19:1 Page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com Description of Respondent's Vehicle: Drivers Lic. No.: Vehicle Lic. No.: Make: Does the Respondent: Carry a weapon or keep a weapon nearby? Have a history of mental illness? Have a history of violence toward others? Other Comments: Where and what kind? Use or abuse alcohol or drugs? What kind? Make threats against law enforcement? Model: Issuing State: Vehicle Year: Color(s): Expiration Year: Issuing State: VIN: Type: DC 19:1 Page 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com