Social Security Numbers, Gender, And Birth Date(S)

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IN THE DISTRICT COURT OF ___________________ COUNTY, NEBRASKA
(county where original action was filed)
THIS DOCUMENT IS CONFIDENTIAL AND SHALL NOT BE MADE PART OF THE CASE FILE OR
PROVIDED TO THE PUBLIC
________________________________,
(name of person listed as plaintiff/petitioner in original action)
Plaintiff/Petitioner,
Case No. CI ____________
(case number assigned by Clerk of Court)
SOCIAL SECURITY NUMBERS,
vs.
GENDER, AND BIRTH DATE(S)
________________________________,
(name of person listed as defendant/respondent in original action)
Defendant/Respondent.
Names
Social Security Number
Gender
Date of Birth
Plaintiff /Petitioner:
__________________
____________________
_______
_____________
Defendant/Respondent:
___________________
____________________
_______
_____________
Minor Children:
___________________
____________________
_______
_____________
___________________
____________________
_______
_____________
___________________
____________________
_______
_____________
___________________
____________________
_______
_____________
___________________
____________________
_______
_____________
(For other information, add pages as required.)
Social Security, Gender, Birth Date, DC 6:5(12),
PSC Nebraska. Adopted 12/17/2008. § 6-1701

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