Nebraska State Court Form DC 6:15(3) NEW 10/18 Neb. Rev. Stat. 247247 42-364(6) and 43-2920 226 43-2943 COMPLAINT FOR MODIFICATION OF CUSTODY OR PARENTING PLAN Page 1 of 6Complaint for Modification Of Custody or Parenting Plan DC 6:15(3) New 10/18 IN THE DISTRICT COURT OF COUNTY, NEBRASKA (county where the original action was filed) (name of plaintiff in original action) Plaintiff vs. (name of defendant in original action) Defendant Case No. CI(case number in original action) COMPLAINT FOR MODIFICATION OF CUSTODY OR PARENTING PLAN I, , without the assistance of an attorney, ask this court (your full name) for an Order of Modification of Parenting Plan. In support of my Complaint, I state that the following is true: 1.I live at , (your street address: if confidential under Nebraska or Federal law, enter county and state only and provide analternative 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 or since birthprior to the filing of the Complaint for Modification. 4.Neither I nor the other party is a member of the Armed Forces of the United States or its allies. 5.I am the biological parent of the following child(ren) whose custody and welfare will beaffected by this proceeding. Their name(s) and year(s) of birth are: (child222s year of birth) (child222s year of birth) (child222s year of birth) (name of child) (name of child) (name of child) (name of child) (child222s year of birth) American LegalNet, Inc. www.FormsWorkFlow.com Page 2 of 6Complaint for Modification Of Custody or Parenting Plan DC 6:15(3) New 10/18 I am a, Both parents are fit and proper person(s) to have the care, custody, andcontrolof our minor child(ren) subject to the other party222s right of parenting time.The following information is provided because of the requirements of the Uniform ChildCustody Jurisdiction and Enforcement Act: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 proceeding concerning the custody of or parenting time with the child(ren). OR 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. American LegalNet, Inc. www.FormsWorkFlow.com Page 3 of 6Complaint for Modification Of Custody or Parenting Plan DC 6:15(3) New 10/18 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 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 American LegalNet, Inc. www.FormsWorkFlow.com Page 4 of 6Complaint for Modification Of Custody or Parenting Plan DC 6:15(3) New 10/18 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 of dissolution,(date of the most recent decree or order that included a parenting plan)order of modification OR order establishing paternity, a parenting plan, and childsupport. 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 issue pendingbefore it as part of its ongoing jurisdiction in family law matters.There has been a material change in circumstances since the date the decree or orderwas 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 enteredby this court be modified. American LegalNet, Inc. www.FormsWorkFlow.com Page 5 of 6Complaint for Modification Of Custody or Parenting Plan DC 6:15(3) New 10/18 WHEREFORE, I ask that this court modify the parenting plan entered on , and: (date of the most recent order that included a parenting plan) (If you are requesting a modification of custody, 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 the child(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 Support Guidelines;andD.Grant any further relief that may be just. Date Name Street Address/P.O. Box E-mail Address City/State/ZIP Code Phone Signature (DO NOT SIGN UNTIL YOU ARE IN THE PRESENCE OF A NOTARY.) American LegalNet, Inc. www.FormsWorkFlow.com Page 6 of 6Complaint for Modification Of Custody or Parenting Plan DC 6:15(3) New 10/18 VERIFICATION STATE OF NEBRASKA ) ) ss COUNTY OF ) (county where signed) I, , first being sworn upon oath, depose (your full name) and say that I am the plaintiff defendant in the above-entitled matter and have read the foregoing Complaint for the Modification of Custody or Parenting Plan and state that the facts contained therein are true. (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 American LegalNet, Inc. www.FormsWorkFlow.com