111 South 18th Plaza, Suite 1152, Omaha, NE 68102-1322 Omaha: (402) 661 - 7350 Fax: (402) 661 - 7387 Toll Free: (866) 220 - 4381 Lincoln: (402) 437 - 1900 Fax: (402) 437 - 1911 Toll Free: (866) 220 - 4379 UNITED STATES DISTRICT COURT FOR THE DISTRICT OF NEBRASKA 2019/2020 BIENNIAL ASSESSMENT Note: The 2019/2020 biennial assessment is $20.00 and must be paid by March 1, 2019. You are not required to complete this form or pay the biennial assessment if you were admitted to the court pro hac vice or if you are an attorney employed by the federal, state, county, city, or local government. In addition, if you are a registered user of CM/ECF, do not complete this form. Instead, you should pay your assessment online. 1 1. Please supply our office with the following information: Name Mailing Address Law Firm Telephone Number Law Firm Fax Number E-mail Address 2. In conjunction with the biennial assessment process, we are asking the following question: Are you willing to accept appointments in civil in forma pauperis cases? Yes No 1 Instructions for paying the assessment online are available on the court's website at http://www.ned.uscourts.gov/internetDocs/cmecf/BiennialAssessmentFee.pdf . American LegalNet, Inc. www.FormsWorkFlow.com