IN THE NEBRASKA WORKERS' COMPENSATION COURT _____________________________________________________________________________________ _____________________________________________________________________________________, [employee name] Plaintiff, vs. _____________________________________________________________________________________ _____________________________________________________________________________________, [name of employer or name of employer and insurance company] Defendant(s). [plaintiff or defendant(s)] ) ) ) ) ) ) ) ) ) ) ) Docket: ___________________________ Page: ____________________________ PRAECIPE FOR TRANSCRIPT COMES NOW the __________________________________________________, and hereby directs that the Clerk of the Nebraska Workers' Compensation Court prepare the Transcript in the above-entitled cause. The Transcript shall contain the following: 1. Petition; 2. Amended Petition(s); 3. Answer; 4. Amended Answer(s); 5. Award, Order of Dismissal, or other decision: __________________________________________________; [title of other decision] 6. Order granting/denying Application to Proceed without Payment of Costs, if issued; In addition, please include the following documents (specifically list any additional case documents you believe are necessary to your appeal; there is no limit to the number of additional documents you request, and you may add numbers as necessary to complete your list): 7. 8. ___________________________________ ___________________________________ 9. ___________________________________ 11. ___________________________________ 12. ___________________________________ 10. ___________________________________ ___________________________________________________________________________________________ [sign your name] ___________________________________________________________________________________________ [print your street address] ___________________________________________________________________________________________ [print your telephone number] ___________________________________________________________________________________________ [print your full name] ___________________________________________________________________________________________ [print your city, state, & zip code] Note: See other side of this form for instructions. Please keep the court informed if you change your address or phone number. CERTIFICATE OF SERVICE The undersigned hereby certifies that a copy of the above Praecipe for Transcript was served upon: [Check one method of service for each party served] Name: __________________________________________________________________________________ [name of service recipient] [street address] Name: __________________________________________________________________________________ [name of service recipient] [street address] Mail: ________________________________________________________________________________ _______________________________________________________________________________ [city, state, & zip code] Mail: ________________________________________________________________________________ _______________________________________________________________________________ [city, state, & zip code] Fax: ________________________________________________________________________________ [fax number, including area code] Fax: ________________________________________________________________________________ [fax number, including area code] Hand Delivery: _____________________________________________________________________ [address where delivered, city, state, & zip code] [electronic mail (e-mail) address] Hand Delivery: _____________________________________________________________________ [address where delivered, city, state, & zip code] [electronic mail (e-mail) address] Electronic Mail: ______________________________________________________________________ Date of Service: ______________________________________________________________________ [month, day, and year that the document was served] Electronic Mail: _____________________________________________________________________ Date of Service: ______________________________________________________________________ [month, day, and year that the document was served] Are there more than two parties to be served? Yes No If so, attach a list of additional recipients to this form. ___________________________________________________________________________________________ [sign your name] ___________________________________________________________________________________________ [print your full name] American LegalNet, Inc. www.FormsWorkFlow.com INSTRUCTIONS FOR PRAECIPE FOR TRANSCRIPT These instructions and forms are a product of the Nebraska Workers' Compensation Court and are provided as a public service. THE NEBRASKA WORKERS' COMPENSATION COURT DOES NOT REPRESENT THAT THESE INSTRUCTIONS AND FORMS WILL BE APPROPRIATE IN EVERY CASE. CASE-SPECIFIC QUESTIONS SHOULD BE DIRECTED TO A LAWYER. COURT PERSONNEL MAY NOT COMPLETE THE FORMS FOR YOU. The Transcript is a copy of case documents such as pleadings, orders, and decisions that have been filed and entered throughout the litigation process. The Court of Appeals looks at the Transcript to determine what issues were presented to the trial court, how the parties brought the issues to the trial court's attention, who the parties are, and the decisions that were made by the trial court.i Upon filing the Notice of Appeal, you should file a Praecipe for Transcript with the Workers' Compensation Court. The clerk's office will prepare the Transcript based on your request and forward it to the Court of Appeals. General questions regarding this process may be directed to the court's information line at 800-599-5155 or 402-471-6468 or you may contact the court by e-mail from our web site (http://www.wcc.ne.gov). Case-specific inquiries should be directed to a lawyer, as the Nebraska Workers' Compensation Court cannot provide legal advice. HEADING Enter the heading as it appears on other previously-filed documents in your case. If you are unsure of the heading information, you may contact the clerk's office to obtain the information. BODY OF THE PRAECIPE Introductory Paragraph: List Items 1-6: List Items 7-continuing: Enter which party you are (plaintiff or defendant(s)). Pursuant to Neb. Ct. R. App. P. § 2-104(1), the clerk must include these pleadings and decisions in the Transcript. For Number 5, please check the box to indic