Clerk of District Court 1701 Farnam Street, Room 300 Omaha, NE 68183 AMOUNT DUE: $_____________ RECORDS REQUEST Files may be viewed within the Office of the Clerk of the District Court. Docket and Page Number (case number):__________________________________________ (if Docket and Page Number is unknown, call (402) 444-7613) Case Caption: _______________________________________________________ Vs. _______________________________________________________ Type of Copy needed (check one or more, and how many copies you need): Photo Copy (Code #28): _______________ (Code #27):_______________ Certified Copy Authenticated Copy (Code #26):_______________ What do you need copied (please include date of action): Complaint ____________________________________________________________________ Decree _______________________________________________________________________ Judgment _____________________________________________________________________ Modifications __________________________________________________________________ Other (be specific): _____________________________________________________________ Why do you need a copy:_________________________________________________________ Contact Information: Name __________________________________ Address __________________________________ __________________________________ Email ____________________________________ Attorney Contact Information: Name __________________________________ Attorney Number _________________ Address __________________________________ __________________________________ Email ___________________________________ Douglas County, NE or Sarpy County, NE Attorneys only: Do you want your request mailed to you? Yes or No PREPAYMENT IS REQUIRED BEFORE ANY COPIES ARE SENT. General Fees: Photo Copies-- $.25 per page Certified Copies (1 seal)----------$3.50 for the first 5 pages of a document, then $.25 per page thereafter. Authenticated Copies (3 seals)---$5.50 for the first 5 pages of a document, then $.25 per page thereafter. A minimum postage and handling fee of $1.00 is added to any standard mailed request. If mailing in a request, please use the "Records Request Form" List the case number of the file, and as much information as possible so your request can be processed quickly and a response generated, (usually within 72 hours), on the fees due. NOTE: A photo ID will be required for any copies requested with `personal identifiers' in the document. CDC­R/R form 01/08 Print Form American LegalNet, Inc. www.FormsWorkFlow.com