Fill and Sign the Case Transfer Form

Nebraska State Court Form CASE TRANSFER SUMMARY FORM JC 14:9 New 01/16 IN THE JUVENILE COURT OF ________________COUNTY, NEBRASKA IN THE INTEREST OF Case #____________________ ________________________________________ (Juvenile) Counts: Violation 1. 2. 3. 4. CASE TRANSFER SUMMARY FORM Date Dismissed? yes no yes no yes no yes no Additional Charges are listed on another sheet. Mothers Name:___________________________ Address:________________________________ City, ST, Zip:_____________________________ Phone No.: ______________________________ Appoint Attorney for Mother? yes no GAL for Mother? yes no Dismissed as to Mother? yes no Fathers Name:___________________________ Address:________________________________ City, ST, Zip:_____________________________ Phone No.: ______________________________ Appoint Attorney for Father? yes no GAL for Father? yes no Dismissed as to Father? yes no Additional Party:__________________________ Relationship: ____________________________ Address:________________________________ City, ST, Zip:_____________________________ Phone No.: ______________________________ Appoint Attorney? yes no GAL? yes no Child(ren): Name(s): __________________________ __________________________ __________________________ Other necessary parties identified The next appearance will be for: Address(es): __________________________ __________________________ __________________________ Case Transfer Summary Form JC 14:9 New 01/16 yes yes yes no no no CASA FCRO NDHHS ICWA Tribe Other: ____________________________________ hearing disposition review Other: ____________________________________ Information provided by: ___________________________ Page 1 of 1 GAL? GAL? GAL?