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Release of Sealed Records Defendants Request Form

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Nebraska State Court Form DC 1:12 NEW 03/2019 Neb. Rev. Stat. REQUEST TO RELEASE SEALED RECORDS Page 1 of 2 Defendant’s Request to Release Sealed Records DC 1:12 New 03/2019 Case No. REQUEST TO RELEASE SEALED RECORDS I, _______________________, request that sealed records in this case be released to: Myself ; or ___________________________________________________________________ ( name of person to receive sealed records) _____________________ ______________________________________________. (address of person to receive sealed records) The re lease of sealed records at my request is allowed by Nebraska Revised Statute I r equest that the following documents from my case be released to the above-n amed person: The entire case file, or The following document(s) (please be specific) ________________________________________________________________________\ ___ ________________________________________________________________________\ ___ I am paying the cost of released copies. Those copy(ies) authorized for r elease can be mailed to the party at the address specified above. Those copy(ies) authorized for release can be mailed t o me at the address specified in the signature block on the next page. The person to whom the documents are released will pay for and pick up the copies. Valid Identification will be required for release of records to the person specified above. DO NOT SIGN UNTI L YOU ARE IN THE PRESENCE OF A NOTARY. SIGNATURE BL OCK AND NOTARY ACKNOWLEDGMENT ARE ON T HE NEXT PAGE. IN THE COURT OF __________________COUNTY , NEBRASKA ( County, District, or Juvenile) (county where original petition filed) Page 2 of 2 Defendant’s Request to Release Sealed Records DC 1:12 New 03/2019 Date Signature Name Street Address/P.O. Box Bar Number and Firm Name (attorneys only) City/State/ZIP Code Phone E-mail Address State of ) ) ss. County of ) The foregoing instrument was acknowledged before me by , this (Name) day of , . (Day) (Month) (Year) Notary Public (Signature of Person Taking Acknowledgment) M y commission expires: (Title or Rank) (Serial Number, if any)

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Fill and Sign the Release of Sealed Records Defendants Request Form