Plaintiffs Claim And Notice To Defendant Small Claims Court

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Nebraska State Court Form

CC 4:1 Rev. 07/15

PLAINTIFF’S CLAIM AND

NOTICE TO DEFENDANT

REQUIRED

Neb. Rev. Stat. §25-2804(3)

(Small Claims Court)

Neb. Ct. R. Ch. 6 Art. 14 App. 4

IN THE COUNTY COURT OF

COUNTY, NEBRASKA

CASE NUMBER

Plaintiff

PLAINTIFF’S CLAIM AND

Street

Address/P.O. Box Number

NOTICE TO DEFENDANT

City/State/ZIP Code

Telephone

E-mail Address

VS.

Defendant

Street

Address/P.O. Box Number

City/State/ZIP Code

Telephone

E-mail Address

Plaintiff states that defendant(s) owe(s) and should be ordered to pay to me the sum of $

and costs of this

action, or return the property valued at $

and costs of this action because on

Plaintiff declares that the defendant(s) is (are) not a “person in the military service of the United States” as defined in Sec. 101 of the Soldiers Relief Act,

1940.

I have filed

small claims this week, and

within the current calendar year.

I elect to have the notice served upon the defendant(s) by:  sheriff/constable  certified mail restricted delivery

 process server.

PLAINTIFF’S SIGNATURE:

DATE:

SIGNED IN MY PRESENCE:

(Seal)

NOTICE TO DEFENDANT

This claim has been filed against you. You must appear before this court on ____________________,_______