Form DC19:49 "Petition and Affidavit to Renew Domestic Abuse Protection Order" - Nebraska

What Is Form DC19:49?

This is a legal form that was released by the United States District Court for the District of Nebraska - a government authority operating within Nebraska. Check the official instructions before completing and submitting the form.

Form Details:

  • Released on August 1, 2017;
  • The latest edition provided by the United States District Court for the District of Nebraska;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form DC19:49 by clicking the link below or browse more documents and templates provided by the United States District Court for the District of Nebraska.

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Download Form DC19:49 "Petition and Affidavit to Renew Domestic Abuse Protection Order" - Nebraska

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Nebraska State Court Form
PETITION AND AFFIDAVIT TO
REQUIRED
Do NOT complete form without reading instructions. Click HERE for Nebraska Self-Help instructions.
RENEW DOMESTIC ABUSE
DC 19:49 Rev. 08/17
PROTECTION ORDER
Neb. Rev. Stat. § 42-924
IN THE DISTRICT COURT OF
COUNTY, NEBRASKA
Petitioner,
Case No.
Additional Petitioner/Minor Child(ren),
Additional Petitioner/Minor Child(ren),
PETITION AND AFFIDAVIT TO
.
RENEW DOMESTIC ABUSE
vs
PROTECTION ORDER
Respondent.
1.
I,
, am petitioning for a renewal of the domestic abuse
protection order issued on ____________________________, (pursuant to Neb. Rev. Stat. § 42-924(3b)).
I am filing this petition on behalf of: (please check one)
Myself. I continue to be in fear for the reason(s) set forth in the original petition and affidavit and/or for the reasons
as set forth in number 11 of this document:
Myself and additional petitioner(s). We continue to be in fear for the reason(s) set forth in the original petition and
affidavit and/or for the reasons as set forth in number 11 of this document:
Only on behalf of the additional petitioner(s) who continues to be in fear for the reason(s) set forth in the original
petition and affidavit and/or for the reasons as set forth in number 11 of this document:
AND:
I am 19 or older or legally emancipated OR
I am a minor and _________ years of age. I
do not speak English. The language that I speak is: _____________________________.
2.
Check Only One:
I have received address protection from the Secretary of State under the Address Confidentiality
Program.(Service of any court process shall be made by mailing two copies of the process to the Office of
Secretary of State, Address Confidentiality Program, Suite 2300, State Capitol Building, Lincoln, NE, 68509)
I am living at a safe house or shelter for my own protection. Pursuant to Neb. Rev. Stat. § 29-4303, I cannot
identify the name, address, location or phone number of the facility.
My address is
(ZIP code)
(Street or Route/Box)
(City)
(State)
Mailing address (if different)
(ZIP code)
(Street or Route/Box)
(City)
(State)
Page 1 of 6
Petition and Affidavit to Renew Domestic Abuse Protection Order
DC 19:49 New 08/17
Nebraska State Court Form
PETITION AND AFFIDAVIT TO
REQUIRED
Do NOT complete form without reading instructions. Click HERE for Nebraska Self-Help instructions.
RENEW DOMESTIC ABUSE
DC 19:49 Rev. 08/17
PROTECTION ORDER
Neb. Rev. Stat. § 42-924
IN THE DISTRICT COURT OF
COUNTY, NEBRASKA
Petitioner,
Case No.
Additional Petitioner/Minor Child(ren),
Additional Petitioner/Minor Child(ren),
PETITION AND AFFIDAVIT TO
.
RENEW DOMESTIC ABUSE
vs
PROTECTION ORDER
Respondent.
1.
I,
, am petitioning for a renewal of the domestic abuse
protection order issued on ____________________________, (pursuant to Neb. Rev. Stat. § 42-924(3b)).
I am filing this petition on behalf of: (please check one)
Myself. I continue to be in fear for the reason(s) set forth in the original petition and affidavit and/or for the reasons
as set forth in number 11 of this document:
Myself and additional petitioner(s). We continue to be in fear for the reason(s) set forth in the original petition and
affidavit and/or for the reasons as set forth in number 11 of this document:
Only on behalf of the additional petitioner(s) who continues to be in fear for the reason(s) set forth in the original
petition and affidavit and/or for the reasons as set forth in number 11 of this document:
AND:
I am 19 or older or legally emancipated OR
I am a minor and _________ years of age. I
do not speak English. The language that I speak is: _____________________________.
2.
Check Only One:
I have received address protection from the Secretary of State under the Address Confidentiality
Program.(Service of any court process shall be made by mailing two copies of the process to the Office of
Secretary of State, Address Confidentiality Program, Suite 2300, State Capitol Building, Lincoln, NE, 68509)
I am living at a safe house or shelter for my own protection. Pursuant to Neb. Rev. Stat. § 29-4303, I cannot
identify the name, address, location or phone number of the facility.
My address is
(ZIP code)
(Street or Route/Box)
(City)
(State)
Mailing address (if different)
(ZIP code)
(Street or Route/Box)
(City)
(State)
Page 1 of 6
Petition and Affidavit to Renew Domestic Abuse Protection Order
DC 19:49 New 08/17
3.
I do not agree to receive notification by e-mail.
I agree to receive notification by e-mail.
e-mail address: _______________________________________________________
NOTE: By providing this e-mail address, I acknowledge that I am aware that this information will be
public record. I also understand that I will only receive e-mail communications regarding this case
from the court.
My relationship to the respondent is: (Check the ONE that best applies):
4.
spouse (husband or wife)
someone I am presently dating
former spouse
someone I have dated in the past
child
someone I am living with
Someone related to me in the following
someone I have lived with in the past
way:
_
the father/mother of one or more of
my children
Not applicable because requesting
only on behalf of other(s)
5.
I am filing this petition against the respondent whose age is:
, and resides at:
(ZIP code)
(Street or Route/Box)
(City)
(State)
Mailing address if different:
(ZIP code)
(Street or Route/Box)
(City)
(State)
(Phone number)
The respondent does not speak English. The language that the respondent speaks is:
6.
The following are identifying characteristics for the respondent : Sex:
Race:
Skin Tone:
Height:
Weight:
Eye Color:
Hair Color:
Driver’s License #:
State:
Exp. Date:
Place of Birth:
Scars/Marks/Tattoos:
Other distinguishing features:
7.
The respondent and I
have
or
have not
been involved in past or current court cases
together. (i.e., divorce, paternity, custody, juvenile, criminal, or protection orders) If so: when, where,
type of case, name of court(s), and case number(s).
Page 2 of 6
Petition and Affidavit to Renew Domestic
Abuse Protection Order
DC 19:49 New 08/17
8.
The respondent and I are parents of the following minor child(ren).
Name
Age
Residence
I am the parent, but the respondent is not the parent, of the following minor child(ren):
9.
I hereby ask the court to renew the existing protection order (mark all that apply):
prohibiting the respondent from imposing any restraint upon me or upon my liberty;
prohibiting the respondent from threatening, assaulting, molesting, or attacking me, or otherwise
disturbing my peace;
prohibiting the respondent from telephoning, contacting, or otherwise communicating with me;
removing and excluding the respondent from my residence;
ordering the respondent to stay away from the following location(s):
(specify address, location description, and connection of place to petitioner)
granting me temporary custody of the following minor children for
days (not to exceed 90
days):
Name:
Age:
Residence:
prohibiting the respondent from possessing or purchasing a firearm as defined in Neb. Rev. Stat. § 28-1201.
ordering any other relief deemed necessary to provide for the safety and welfare of me and any designated
family or household member, (describe relief requested and why):
I request to have a
District Court Judge, or a
10.
County Court Judge preside over this
proceeding.(I understand this request may not be granted.).
Page 3 of 6
Petition and Affidavit to Renew Domestic
Abuse Protection Order
DC 19:49 New 08/17
11.
I am seeking a renewal for the following additional reason(s) (If needed, please write a brief but detailed
description of the additional events and/or reasons.):
No additional events have occurred since the original Petition and Affidavit for Domestic Abuse
Protection Order was filed.
A. Date/Time (If needed):
Description:
B. Date/Time (if needed):
Description:
C. Date/Time (if needed):
Description:
Page 4 of 6
Petition and Affidavit to Renew Domestic
Abuse Protection Order
DC 19:49 New 08/17
Additional Petitioner(s)
12.
(if needed):
Additional Petitioner 2 (Minor Child):
Name:
Age:
Relationship to the Respondent (from list on number 4):
.
_____________________________________
.
Residence:
The address of this Petitioner is the same as my address above.
This Petitioner’s address is:
(Street or Route/Box)
(City)
(State)
(Zip)
Additional Petitioner 3 (Minor Child):
Name:
Age:
Relationship to the Respondent (from list on number 4):
_____________________________________
.
.
Residence:
The address of this Petitioner is the same as my address above.
This Petitioner’s address is:
(Street or Route/Box)
(City)
(State)
(Zip
Additional Petitioner 4 (Minor Child):
Name:
Age:
Relationship to the Respondent (from list on number 4):
.
_____________________________________
.
Residence:
The address of this Petitioner is the same as my address above.
This Petitioner’s address is:
(Street or Route/Box)
(City)
(State)
(Zip)
Additional Petitioner 5 (Minor Child):
Name:
Age:
Relationship to the Respondent (from list on number 4):
.
_____________________________________
.
Residence:
The address of this Petitioner is the same as my address above.
This Petitioner’s address is:
(Street or Route/Box)
(City)
(State)
(Zip)
Additional Petitioner 6 (Minor Child):
Name:
Age:
Relationship to the Respondent (from list on number 4):
.
_____________________________________
.
Residence:
The address of this Petitioner is the same as my address above.
This Petitioner’s address is:
(Street or Route/Box)
(City)
(State)
(Zip)
Page 5 of 6
Petition and Affidavit to Renew Domestic
Abuse Protection Order
DC 19:49 New 08/17
Page of 6