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Fill and Sign the Master Forms List Page 3 Nebraska Judicial Branch

Fill and Sign the Master Forms List Page 3 Nebraska Judicial Branch

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Nebraska State Court Form DC 6:5.9 Rev. 06/19 ATTORNEY CERTIFICATE OF PROVIDING PARENTING ACT INFORMATION Neb. Rev. Stat. § 43-2925(3). IN THE DISTRICT COURT OF ________________ COUNTY, NEBRASKA Case No.___________________ , Plaintiff, ATTORNEY CERTIFICATE OF PROVIDING PARENTING ACT INFORMATION vs. , Defendant. The undersigned attorney for the _________________________________ (plaintiff or defendant) hereby certifies to the court that required Parenting Act information pursuant to Neb. Rev. Stat. § 43-2925 has been provided to the undersigned’s client in this action. Date Signature Name Bar Number and Firm Name (attorneys only) Street Address/P.O. Box City/State/ZIP Code Phone Page 1 of 1 Attorney Certificate of Providing Parenting Act Information DC 6:5.9 Rev. 06/19 E-mail Address

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