Nebraska State Court Form JURY TRIAL REQUESTCC 6:13 Revised 01/15 Page 1 of 1 Jury Trial Request CC 6:13 Rev. 01/15 IN THE COUNTY COURT OF COUNTY, NEBRASKA State of Nebraska Plaintiff vs. Defendant Case JURY TRIAL REQUEST I, the efendant in this matter, have been accused of the charge(s) of . I understand a conviction under the charge(s) could result in my incarceration. As the charge(s) is/are Class II, III, IIIA, or W misdemeanor charge(s) and the case is not a criminal case arising under city or village ordinances, traffic, or other infraction, I have the right to a jury trial so long as I submit a request for jury trial within 10 days from the filing of a plea. Accordingly, I request a jury trial regarding the above stated charges. Date Signature Name Bar Number and Firm Name (attorneys only) Street Address/P.O. Box City/State/ZIP Code Phone E-mail Address CERTIFICATE I certify that a copy of this Jury Trial Request was served on the prosecuting attorney and the court on mail , by the following method:personal service other Date: American LegalNet, Inc. www.FormsWorkFlow.com