SMALL CLAIMS CERTIFIED MAIL RETURN Nebraska State Court Form REQUIRED CC 4:5Neb. Rev. Stat. 25-2804(3) IN THE COUNTY COURT OF COUNTY, NEBRASKA Plaintiff vs. Defendant Case SMALL CLAIMS CERTIFIED MAIL RETURN I acknowledge that a copy of the small claims complaint was mailed to each defendant by certified mail, return receipt requested. Defendant: Case Number: Trial Date: 1.Certified mail was mailed on 2.Return receipt was signed on 3.Certified mail was returned unsigned on 4.Postage $ Date Signature Name (Plaintiff) Street Address/P.O. Box City/State/ZIP Code Phone E-mail Address Page of 2Small Claims Certified Mail Return CC 4:5 Rev. American LegalNet, Inc. www.FormsWorkFlow.com These written instructions are prepared by the State Court Administrator in accordance with the provisions of Neb. Rev. Stat.25-2804(3) and are available at http://supremecourt.ne.gov/forms . NOTICE TO PLAINTIFF: Notice shall be served on each defendant not less than five days before the time set for hearing. Proper service on the defendant is essential, without it your lawsuit will be dismissed. Since you have chosen to have your small claims claim served upon the defendant by certified mail, you should follow these instructions. 1.Place a copy of your claim in an envelope of sufficient size, addressed to the defendant andtake it to a United States Post Office. 2.Inform the postal clerk that you want the letter mailed by Certified Mail - Restricted Delivery - Return Receipt Requested. (Although Restricted Delivery is not required by statute, most judges will require proof of service upon the actual defendant, as opposed to just any personshe does not appear at the scheduled hearing.) 3.You will be charged: a.Postage $ 0. b.Certified Mail $ c.Restricted Delivery $ d. Return Receipt Requested $ Total: $ 4. They will give you Form 3800, Receipt for Certified Mail. Enter the address of the defendanton the top portion of the receipt, then detach the label with the certified number and place it onthe letter above the address and to the right of the return address. *An electronic ReturnReceipt is available for a reduced charge of $1..Talk to your post master for moreinformation. 5.Restricted DeliveryReturn Receipt Requestedf the envelope. . 6.Give it to the postal clerk who will check it over, collect your fees and return a copy of Form3800 to you which will be your proof of certified mailing. 7.Once the certified mail is delivered to the defendant, the postal clerk will send you a returnedThis is your proof of personal service on the defendant. 8.If the mail is not delivered, the postal clerk will leave a notice of certified mail at themail is not called for, a final notice is issued. Themail will be returned to you 15 days after the first unsuccessful delivery attempt. 9.Proper service on the defendant is essential. If you are unsuccessful, you will have to beginthe service process all over again. RETURN INSTRUCTIONS: Complete the preceding form, then attach the green certified mail return receipt postcard to the top of the form and return it to the Clerk of the Court at least five days prior to the trial date. Page 2 of 2 Small Claims Certified Mail ReturnCC 4:5 Rev. American LegalNet, Inc. www.FormsWorkFlow.com