DISMISSAL (Small Claims Court) IN THE COUNTY COURT OF COUNTY, NEBRASKA Plaintiff vs. Defendant the laintiff herein, and dismisses the above captioned small claim with prejudice (the claim cannot be refiled). without prejudice (the claim can be refiled). Date Signature Name (Plaintiff) Street Address/P.O. Box City/State/ZIP Code E-mail Address Certificate of Service I hereby certify that a copy of this Dismissal has been sent by first class mail to the defendant at the following address: Date: . By: Plaintiff American LegalNet, Inc. www.FormsWorkFlow.com