Instructions for Form DC19:2 "Petition and Affidavit to Obtain Harassment Protection Order" - Nebraska

This document contains official instructions for Form DC19:2, Petition and Affidavit to Obtain Harassment Protection Order - a form released and collected by the United States District Court for the District of Nebraska. An up-to-date fillable Form DC19:2 is available for download through this link.

Instruction Details:

  • This 2-page document is available for download in PDF;
  • Actual and applicable for the current year;
  • Complete, printable, and free.

Download your copy of the instructions by clicking the link below or browse hundreds of other forms in our library of forms released by the United States District Court for the District of Nebraska.

ADVERTISEMENT
ADVERTISEMENT

Download Instructions for Form DC19:2 "Petition and Affidavit to Obtain Harassment Protection Order" - Nebraska

323 times
Rate (4.7 / 5) 19 votes
INSTRUCTIONS FOR FILLING OUT PETITION AND AFFIDAVIT FOR
HARASSMENT PROTECTION ORDER.
NOTE: THE USE OF THE INFORMATION WORKSHEET FOR THE HARASSMENT
PROTECTION ORDER WILL ASSIST YOU IN COMPLETING THIS FORM.
HEADING:
Enter the name of the county where you are filing this petition and affidavit.
Enter the first, middle and last names of the petitioner (your name).
Enter the first, middle and last names of the additional petitioner(s) or minor children who are to be
covered by THIS petition and affidavit. PLEASE NOTE: Some courts require a separate petition
for each person seeking protection. Check with the court in which you will be filing the request.
Enter the first, middle and last names of the respondent (the other party’s name).
The case number will be assigned by the clerk of the district court.
BODY OF PETITION AND AFFIDAVIT:
The numbers below give instructions for completing the paragraphs with the same numbers in
the Petition and Affidavit.
Paragraph 1. Enter your full name in the first paragraph.
Check the box that represents your role in this case.
For instance – if you check the first box, the request is for protection just for yourself.
If you check the second box you are asking for protection for you AND the
“additional petitioners/minor children” who are listed in the heading and are also
afraid of harassment. If you check the third box, the protection requested is only
for “additional petitioners/minor children” listed in the heading, BUT not for yourself.
If you check either the second or the third box, you will also check the box that
represents your relationship to the additional petitioner(s) and/or minor child(ren).
Check the box that is correct for if you are 19 or older or legally emancipated or if you
are a minor. IF YOU ARE A MINOR – enter your age in the box provided.
Check the next box if you do NOT speak English. If you check the box, enter the
language that you speak.
Paragraph 2. Check the box for either: you have received address protection, you are living at a
safe house, or that you are providing your address. If you check the third option, enter
your street address in the space provided. If your mailing address is different from your
street address enter what your mailing address is on the next line.
Paragraph 3. Check the correct box of Paragraph 3. If you check the box that you agree to receive e-
mails, enter your e-mail address.
Paragraph 4. Enter the age of the respondent in the first blank. Enter the respondent’s street address
on the next line. If the respondent’s mailing address is different from their street address,
enter the mailing address on the next line in the paragraph. On the following line, enter
the respondents telephone number.
Check the next box if the respondent does NOT speak English. If you check the box,
enter the language that they speak.
Enter your relationship to the respondent (if any).
Page 1 of 2
Instructions for Petition and
Affidavit for Harassment
Protection Order
DC 19:2A New 11/17
INSTRUCTIONS FOR FILLING OUT PETITION AND AFFIDAVIT FOR
HARASSMENT PROTECTION ORDER.
NOTE: THE USE OF THE INFORMATION WORKSHEET FOR THE HARASSMENT
PROTECTION ORDER WILL ASSIST YOU IN COMPLETING THIS FORM.
HEADING:
Enter the name of the county where you are filing this petition and affidavit.
Enter the first, middle and last names of the petitioner (your name).
Enter the first, middle and last names of the additional petitioner(s) or minor children who are to be
covered by THIS petition and affidavit. PLEASE NOTE: Some courts require a separate petition
for each person seeking protection. Check with the court in which you will be filing the request.
Enter the first, middle and last names of the respondent (the other party’s name).
The case number will be assigned by the clerk of the district court.
BODY OF PETITION AND AFFIDAVIT:
The numbers below give instructions for completing the paragraphs with the same numbers in
the Petition and Affidavit.
Paragraph 1. Enter your full name in the first paragraph.
Check the box that represents your role in this case.
For instance – if you check the first box, the request is for protection just for yourself.
If you check the second box you are asking for protection for you AND the
“additional petitioners/minor children” who are listed in the heading and are also
afraid of harassment. If you check the third box, the protection requested is only
for “additional petitioners/minor children” listed in the heading, BUT not for yourself.
If you check either the second or the third box, you will also check the box that
represents your relationship to the additional petitioner(s) and/or minor child(ren).
Check the box that is correct for if you are 19 or older or legally emancipated or if you
are a minor. IF YOU ARE A MINOR – enter your age in the box provided.
Check the next box if you do NOT speak English. If you check the box, enter the
language that you speak.
Paragraph 2. Check the box for either: you have received address protection, you are living at a
safe house, or that you are providing your address. If you check the third option, enter
your street address in the space provided. If your mailing address is different from your
street address enter what your mailing address is on the next line.
Paragraph 3. Check the correct box of Paragraph 3. If you check the box that you agree to receive e-
mails, enter your e-mail address.
Paragraph 4. Enter the age of the respondent in the first blank. Enter the respondent’s street address
on the next line. If the respondent’s mailing address is different from their street address,
enter the mailing address on the next line in the paragraph. On the following line, enter
the respondents telephone number.
Check the next box if the respondent does NOT speak English. If you check the box,
enter the language that they speak.
Enter your relationship to the respondent (if any).
Page 1 of 2
Instructions for Petition and
Affidavit for Harassment
Protection Order
DC 19:2A New 11/17
Paragraph 6. Check the appropriate box. IF you AND the respondent HAVE been involved in a past or
current court case together, enter the name of the court, the case number, the type of
case and the date of the determination.
Paragraph 7. Check all the boxes that apply for the types of protection you are requesting.
Paragraph 8.
Check the appropriate box.
Paragraph 9. Write a brief, but detailed description of the MOST RECENT series of acts of harassment
toward the person(s) seeking protection.
Paragraph 10. Enter the information for EACH of the additional petitioner(s)/minor child(ren). This
information includes their full name, their age, their relationship to the respondent (this a
drop down list if this form is being completed on line), check box if their address is the
same as your address, or check box and available space if their address is different from
your address.
SIGNATURE BLOCK:
DO NOT SIGN THIS COMPLAINT UNTIL YOU ARE PRESENT IN FRONT OF A NOTARY OR THE
CLERK OF THE DISTRICT COURT.
NOTARY VERIFICATION STATEMENT:
THIS WILL BE COMPLETED BY THE CLERK OF THE DISTRICT COURT OR BY A NOTARY
Page 2 of 2
Instructions for Petition and
Affidavit for Harassment
Protection Order
DC 19:2A New 11/17
Page of 2