IN THE _____________COURT OF DOUGLAS COUNTY, NEBRASKA THIS DOCUMENT IS CONFIDENTIAL AND SHALL NOT BE MADE PART OF THE COURT FILE OR PROVIDED TO THE PUBLIC PURSUANT TO NEB. CT. R. OF DIST. CTS. 21. _________________, Plaintiff, v. ) ) ) ) ) ) ) ) ) ) Case Number ____________ SOCIAL SECURITY NUMBERS, GENDER, AND BIRTH DATES ________________, Defendant. Names Plaintiff: ________________ Defendant: ________________ Minor Children: ________________ ________________ ________________ ________________ Social Security Number Gender Birth Date _____________________ _______ ______________ _____________________ _______ ______________ _____________________ _____________________ _____________________ _____________________ _______ _______ _______ _______ ______________ ______________ ______________ ______________ (For other information, add pages as required.) Appendix 3 PRINT This form is neither approved nor disapproved by any court or judicial tribunal. Use of this form provides no immunity from error. American LegalNet, Inc. www.FormsWorkFlow.com