Form DC19:23 "Request for Modification to Harassment Protection Order" - Nebraska

What Is Form DC19:23?

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. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on November 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 DC19:23 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 DC19:23 "Request for Modification to Harassment Protection Order" - Nebraska

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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
Page of 2