Nebraska State Court Form AFFIDAVIT IN SUPPORT OF _______________________________________________

CC 3:28 New 06/18

________________________________ Plaintiff

vs.

________________________________ Defendant

Case No.____________________

AFFIDAVIT IN SUPPORT OF _______________________________________________

STATE OF NEBRASKA) ) ss:

COUNTY OF _____________ ) (County where signed)

I, __________________________, being duly sworn under oath, say: (your full name)

_____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ____________________________________________________________________________________________________________________________________________

Page 1 of 1Affidavit CC 3:28 New 06/18

Date Signature (your signature)

Your Full Name

Your Full Street Address/P.O. Box

City/State/ZIP Code

Phone Email Address

SUBSCRIBED AND SWORN to before me this ______ day of _____________, 20___.

________________________________ Notary Public

(name of person listed as plaintiff in original action)

(name of person listed as defendant in original action)

(case number assigned by clerk of court)

****DO NOT SIGN UNTIL YOU ARE IN THE PRESENCE OF A NOTARY***