Fill and Sign the Dc 1941 New 0817 Form

Nebraska State Court Form DC 19:41 NEW 08/17 Neb. Rev. Stat. §§ 42-924, 28-311.09, and 28-311.11 APPLICATION TO DISMISS PETITION AND AFFIDAVIT TO OBTAIN OR RENEW A PROTECTION ORDER IN THE DISTRICT COURT OF COUNTY, NEBRASKA ________________________________________ Petitioner, Case No. ____________________ _________________________________________ Additional Petitioner/Minor Child(ren), _________________________________________ Additional Petitioner/Minor Child(ren), vs. APPLICATION TO DISMISS PETITION AND AFFIDAVIT TO OBTAIN OR RENEW A PROTECTION ORDER _________________________________________ Respondent. Comes now the petitioner and hereby requests the court to dismiss the Petition and Affidavit to Obtain or Renew a Protection Order filed by the petitioner on __________________________. In support of this request, the petitioner sets forth the following. This request is being done by the petitioner as a free and voluntary act. DATED: ________________________. (do NOT sign UNTIL THE CLERK OF THE DISTRICT COURT OR A NOTARY IS PRESENT AND WITNESSES YOU SIGNING) Signature of Petitioner Date 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 this _______ day of ______________________, 20_______. _________________________________ Clerk of District Court/Notary Public Page 1 of 1 Application to Dismiss Petition and Affidavit to Obtain Protection Order DC19:41 NEW 0817