STATE OF NEBRASKA FORM NO. DC 19-1 Rev. 6/08 Neb. Rev. Stat. §42-924 - 28311.09
CASE NUMBER:
PROTECTION ORDER PRAECIPE
DOCUMENT NO.:
IN THE DISTRICT COURT OF
COUNTY, NEBRASKA
Petitioner vs.
PRAECIPE
Respondent
TO THE CLERK OF COURT: Please have the Sheriff of County serve a certified copy of the protection
order and/or order to show cause, petition, and request for hearing (if applicable) upon the respondent by personal service at any one of the following addresses: Home: Work: Other locations where respondent can be found: Directions for Service:
Petitioner Address
Telephone (If you are concealing your address or phone, do not provide them. Make separate arrangements with the clerk.)
Fill in any of the following information if known. Description of Respondent: Alias: Sex: Eye Color: Skin Tone: Age: Height: Hair Color: Place of Birth: Weight: Race:
Describe Scars, Marks, Beards, Tattoos, etc.: Employer: Work Days and Hours:
Description of Respondent's Vehicle: Drivers Lic. No.: Vehicle Lic. No.: Make: Model: Issuing State: Vehicle Year: Color(s): Expiration Year: Issuing State: VIN: Type:
Does the Respondent: Carry a weapon or keep a weapon nearby? Have a history of mental illness? Have a history of violence toward others? Other Comments: Where and what kind? Use or abuse alcohol or drugs? What kind?
Make threats against law enforcement?