Fill and Sign the Master Forms List Page 4 Nebraska Judicial Branch Nebraskagov

Court Media Credential Badge Application Janet Bancroft, Public Information Officer 402-471-3730 | nsc.courtservices@nebraska.gov New Application for Media Identification Card Replacement Card – original card was: Misplaced Damaged First Name: ______________________________________________________________ Last Name: ______________________________________________________________ Media Outlet: ______________________________________________________________ Work Address: ______________________________________________________________ ______________________________________________________________ Phone: work: __________________________ cell: ___________________________ Email: ______________________________________________________________ My organization holds a license from the Federal Communications Commission. My organization is a newsgathering entity that publishes on a regular/ongoing schedule. *Please submit a head-and-shoulders photo with this application by attaching a .jpg file of your photo to the e-mail that is generated when the below “Submit” button is pressed. For Questions/Concerns contact: Nebraska Supreme Court Office of Public Information Submit by E-mail Print Form 1213 State Capitol, Lincoln, NE 68509 nsc.courtservices@nebraska.gov (402)471-3730 FOR OFFICE USE ONLY Date of Approval: ______________________________ Badge Number: ________________________________ Authorized by: _______________________________________________ Page 1 of 1 AD 1:06 New 01/2017 Court Media Credential Badge Application Pursuant to Neb. Ct. R. § 6-2003(K)