N ebraska State Court Form DC 6:15(6) ANSWER AND COUNTERCLAIM TO COMPLAINT FOR MODIFICATION IN THE DISTRICT COURT OF COUNTY, NEBRASKA (county where the original action was filed) Case No. CI (case number in original action) ANSWER AND COUNTERCLAIM TO COMPLAINT FOR MODIFICATION ANSWER COMES NOW, , the plaintiff (your full name) defendant in the above-captioned matter, and for the Answer to the other party222s Complaint for Modification, hereby admits, denies, and alleges as follows: 1.Admits Paragraph(s) of (paragraph number(s) with which you agree)the Complaint for Modification. 2.Denies Paragraph(s) of(paragraph number(s) with which you disagree)the Complaint for Modification. COUNTERCLAIM I , the plaintiff defendant in (your full name) the above entitled action, without assistance of an attorney, hereby state and allege as follows: I live at , (your street address: if confidential under Nebraska or Federal law, enter county and state only and provide an alternative address for mailing of notice) in (city, county, and state where you live) 2.The other party222s address is: (street address) in . (city, county and state where the other party lives) 3.The minor child(ren) has/have lived in the state of Nebraska for at least 6 months orsince birth prior to the filing of the Complaint for Modification. Page 1 of 6 (name of plaintiff in original action) Plaintiff vs. (name of defendant in original action) American LegalNet, Inc. www.FormsWorkFlow.com Page 2 of 6 Neither I nor the other party is a member of the Armed Forces of the United States or its (name of child) (child222s year of birth) (name of child) (child222s year of birth) (child222s year of birth) (name of child) (name of child) (child222s year of birth) 6. I am a, Both parents are fit and proper person(s) to have the care, custody, andcontrol of our minor child(ren) subject to the other party222s right of parenting time. 7.The following information is provided because of the requirements of the UniformChildCustody Jurisdiction and Enforcement Act: (a)For the last five years, the child(ren)222s addresses and the persons theyhave lived with are: DATES: ADDRESS: NAME and CURRENT ADDRESS OF PERSON(S) WITH WHOM THE CHILD(REN) HAVE LIVED: (b)Check the box that applies: I have not been a party or a witness in any other proceedingconcerning the custody of or parenting time with the child(ren). OR American LegalNet, Inc. www.FormsWorkFlow.com Page 3 of 6 I have been a party or a witness in another proceeding concerning the custody of or parenting time with the child(ren), as follows: (name of court) (case number) (date of child custody determination, if any) (c)Check the box that applies: I know of no other actions or proceedings that could affectthis action. This includes actions or proceedings about domestic violence, protection orders, termination of parental rights, and adoptions. OR There is currently a proceeding which could affect this action. (name of court) (case number) (date determination, if any) (d)Check the box that applies: I do not know the names and addresses of any persons otherthan the other party and myself who have physical custody of the child(ren) or claim to have custody or parenting time rights with the child(ren). OR American LegalNet, Inc. www.FormsWorkFlow.com Page 4 of 6 The following is a list of the names and addresses of persons other than the other party and myself who have physical custody of the child(ren) or claim to have custody or parenting time rights with the child(ren): NAME: ADDRESS: 8. able to provide support for the child(ren). (223I am224 or 223The other party is224) 9.Check the box that applies: There are no existing restraining orders, protection orders, or criminal no-contact orders regarding either party. OR There are one or more existing restraining orders, protection orders, or criminal no-contact orders regarding one or more of the parties. Details are as follows: Type(s) of order(s): restraining; protection; criminal no-contact.Name of court, case number, and date of order for eachorder:(name of court, case number and date of each order) A modified parenting plan has has not been developed.Child custody is is not contested.Parenting time is is not contested.Child support is is not contested.On this court entered a decree ofdissolution,(date of the most recent decree or order that included a parenting plan)order of modification OR order establishing paternity, a parenting plan, andchild support. As part of that decree or order, the court ordered a parenting plan.This court has jurisdiction over the parties to this proceeding and over the issuepending before it as part of its ongoing jurisdiction in family law matters. American LegalNet, Inc. www.FormsWorkFlow.com Page 5 of 6 14.There has been a material change in circumstances since the date the decree or order was entered. Specifically, the following change(s) has (have) occurred: 15.It is in the best interests of the minor child(ren) that the parenting plan previously entered by this court be modified. WHEREFORE, I request the court: If the party that filed the Complaint for Modification is requesting a modification ofcustody, check the box that applies:Award sole legal and sole physical custody of the child(ren).(name of party) Award plaintiff and defendant joint legal custody of the child(ren) and award solephysical custody of the child(ren) to . (name of party)Award plaintiff and defendant joint legal and joint physical custody of thechild(ren). B.Order a modified parenting plan that sets forth parenting time with each parent.C.Award child support in a manner consistent with the Nebraska Child SupportGuidelines; and D.Grant any further relief that may be just. Date Signature (DO NOT SIGN UNTIL YOU ARE IN THE PRESENCE OF A NOTARY.) Name Street Address/P.O. Box E-mail Address City/State/ZIP Code Phone American LegalNet, Inc. www.FormsWorkFlow.com Page 6 of 6 Answer and Counterclaim to Complaint for Modification DC 6:15(6) VERIFICATION STATE OF NEBRASKA ) ) ss COUNTY OF ) (county where signed) I, , first being sworn upon oath, depose (your full name) (Your Signature. DO NOT SIGN UNTIL YOU ARE IN FRONT OF THE NOTARY) SUBSCRIBED AND SWORN to before me this day of , 20. Notary Public CERTIFICATE OF SERVICE I hereby certify that on (date) foregoing Answer and Counterclaim for was sent by first-class mail, postage prepaid, to at . (spouse222s address, including street address, city, state, and ZIP code) (your name) American LegalNet, Inc. www.FormsWorkFlow.com