Fill and Sign the Notice to Parent of Form

IN THE DISTR ICT COURT OF ________________ COUNTY, NEBRASKA (c ounty where Petition filed) IN RE NAME CHANGE OF CASE No.___________________ (case number assigned by Clerk of Court) ______________________________ (minor child(ren)’s current full name(s)) NOTICE TO PARENT OF HEARING FOR THE NAME CHANGE OF A MINOR CHILD______________________________ ______________________________ ______________________________ Minor Child(ren), By Next Friend, ______________________________ . (your full name) You are hereby notified that the hearing for the name change of _____________ _____________________________________________________________________, (minor child(ren)’s current full name(s)) minor child(ren), by the next friend, _______________________________, will be (your full name) heard before the Honorable _________________________, Judge of the District Court (name of judge hearing your case) of ____________________ ___ County, in Courtroom No. ______________ at (county where Petition filed) (courtroom number)___________________________________________________________________, on (courthouse address where hearing will be held) _______________________ at _______________, or as soon thereafter as it may be (month/day/year) (time of hearing) heard. Date Petitioner’s Signature (your signature) Your Full Name Your Full Street Address/P.O. Box City/State/ZIP Code Phone E-mail Address NOTICE TO PARENT OF HEARING FOR THE NAME CHANGE OF A MINOR CHILD N ebraska State Court Form DC 6:11(4) R ev. 05/15 Page 1 of 2 Notice to Parent for Hearing of the Name Change of a Minor Child DC 6:11(4) Rev. 5/15 Neb. Rev. Stat. § 25-21, 271 CERTIF ICATE OF SERVICE I hereby certify that on the _____ day of ________________, 20___, a true copy (day) (month) (year) of the foregoing Notice to Parent was sent by certified mail to ____________________ _ (other parent’s name)_________________ at __________________________________________________. (other parent’s street address, city, state and ZIP code) Date Petitioner’s Signature (your signature) Your Full Name Your Full Street Address/P.O. Box City/State/ZIP Code Phone E-mail Address Page 2 of 2 Notice to Parent for Hearing of the Name Change of a Minor Child DC 6:11(4) Rev. 5/15