Nebraska State Court Form REQUIRED COUNTY COURT APPEAL TO DISTRICT COURT CERTIFICATE OF TRANSCRIPT Ch. 6, Art. 14, App. 1 Effective 1/1/15, (CC 9:5) Neb. Ct. R. §6-1452(A)(3)(d) IN THE COURT OF COUNTY, NEBRASKA Case #. _____________ APPEARANCES: For the Plaintiff: Name Bar Number and Firm Name (attorneys only) Street Address/P.O. Box Number City/State/ZIP Code Phone E-mail Address _______________________________ Plaintiff vs. For the Defendant: Name Bar Number and Firm Name (attorneys only) ________________________________ Defendant Street Address/P.O. Box Number City/State/ZIP Code Phone E-mail Address CERTIFICATE OF TRANSCRIPT I, , Clerk of the County Court, certify that the attached are true and accurate copies of the pleadings filed in this case. (Index attached). The notice of appeal was filed on The District Court filing fee in the amount of $ A poverty affidavit (copy attached) was filed on I further certify that the following costs ( have) ( have not) been paid: Filing Fee LEIF Judges Retirement Automation Fee $ $ $ $ NSC Education Fee Dispute Resolution Fee Indigent Defense Fee Uniform Data Analysis Fee Legal Services Fee $ $ $ $ $ Services Fees Witness Fees Transcript Fees Bill of Exceptions Other TOTAL $_ $_ $_ $ $_ $_ , was paid on . , , . , or Date: (Seal) Page 1 of 1 County Court Appeal to District Court Certificate of Transcript CC 9:5 Rev 01/15 By the Court: Clerk Appendix 1 (Neb. Ct. R. ­ Chapter 6, Article 14) Revised pursuant to Neb. Ct, R. §6-111 01/2015 American LegalNet, Inc. www.FormsWorkFlow.com