Form DC 19:23 Request for Modification to Harassment Protection Order - Nebraska

Form DC19:23 is a United States District Court for the District of Nebraska form also known as the "Request For Modification To Harassment Protection Order". The latest edition of the form was released in November 1, 2017 and is available for digital filing.

Download a PDF version of the Form DC19:23 down below or find it on United States District Court for the District of Nebraska Forms website.

ADVERTISEMENT
REQUEST FOR
Nebraska State Court Form
MODIFICATION TO
HARASSMENT
DC 19:23 Rev. 11/17
PROTECTION ORDER
Neb. Rev. Stat. § 28-311.09
IN THE DISTRICT COURT OF
COUNTY, NEBRASKA
________________________________________
Petitioner,
________________________________________
Additional Petitioner/Minor Child(ren),
Case No. ____________________
________________________________________
Additional Petitioner/Minor Child(ren),
vs.
________________________________________
REQUEST FOR MODIFICATION TO
Respondent.
HARASSMENT PROTECTION ORDER
1. I/We, ______________________________________, am/are the petitioner(s) in this case. I am requesting a
modification to the existing harassment protection order issued on,
, pursuant to
Neb. Rev. Stat. § 28-311.09.
2. This request will apply to the following protected party(ies):
1.________________________________
4.________________________________
2.________________________________
5.________________________________
3.________________________________
6.________________________________
3. The modification(s) requested is/are detailed below:
4. Reasons for modification are stated below:
Page 1 of 2
Request for Modification to
Harassment Protection Order
DC 19:23 Rev. 11/17
REQUEST FOR
Nebraska State Court Form
MODIFICATION TO
HARASSMENT
DC 19:23 Rev. 11/17
PROTECTION ORDER
Neb. Rev. Stat. § 28-311.09
IN THE DISTRICT COURT OF
COUNTY, NEBRASKA
________________________________________
Petitioner,
________________________________________
Additional Petitioner/Minor Child(ren),
Case No. ____________________
________________________________________
Additional Petitioner/Minor Child(ren),
vs.
________________________________________
REQUEST FOR MODIFICATION TO
Respondent.
HARASSMENT PROTECTION ORDER
1. I/We, ______________________________________, am/are the petitioner(s) in this case. I am requesting a
modification to the existing harassment protection order issued on,
, pursuant to
Neb. Rev. Stat. § 28-311.09.
2. This request will apply to the following protected party(ies):
1.________________________________
4.________________________________
2.________________________________
5.________________________________
3.________________________________
6.________________________________
3. The modification(s) requested is/are detailed below:
4. Reasons for modification are stated below:
Page 1 of 2
Request for Modification to
Harassment Protection Order
DC 19:23 Rev. 11/17
NOTE: DO NOT SIGN UNTIL THE CLERK OF THE DISTRICT COURT OR A NOTARY IS PRESENT AND
WITNESSES YOU SIGNING
I hereby swear, or affirm, under penalty of perjury, the forgoing is true.
do not provide them
*If you are concealing your address or phone,
. Make separate arrangements with the clerk.
Date
Signature of Petitioner
Name
* Street Address/P.O. Box
Bar Number and Firm Name (attorneys only)
City/State/ZIP Code
Phone
E-mail Address
Subscribed and sworn before me on
,
Clerk of the District Court/Notary Public
(Seal)
My Commission Expires: ____________________
Page 2 of 2
Request for Modification to
Harassment Protection Order
DC 19:23 Rev. 11/17

Download Form DC 19:23 Request for Modification to Harassment Protection Order - Nebraska

1289 times
Rate
4.6(4.6 / 5) 77 votes
ADVERTISEMENT
Page of 2