Page 1 of 1 AD 1:06 New 01/2017 Court Media Credential Badge Application Pursuant to Neb. Ct. R. 2476-2003(K) New Application for Media Identification Card Replacement Card 226 original card was: Misplaced Damaged First Name: Last Name: Media Outlet: Work Address: Phone: work: cell: Email: My organization holds a license from the Federal Communications Commission.My organization is a newsgathering entity that publishes on a regular/ongoing schedule. *Please submit a head-and-shoulders photo with this application by attaching a .jpg file of your photo tothe e-mail that is generated when the below 223Submit224 button is pressed. Court Media Credential Badge Application Janet Bancroft, Public Information Officer 402-471- | @nebraska.gov FOR OFFICE USE ONLY Date of Approval: Badge Number: Authorized by: For Questions/Concerns contact: Nebraska Supreme Court Office of Public Information 1213 State Capitol, Lincoln, NE 68509 sc.courtservices@nebraska.gov (402)471- American LegalNet, Inc. www.FormsWorkFlow.com