STATE OF NEBRASKA FORM NO. CC 17:6 NEW 10/06
CASE NUMBER
CERTIFICATION OF ADOPTION
COUNTY, NEBRASKA
IN THE COUNTY COURT OF
IN THE MATTER OF THE ADOPTION OF
CERTIFICATION OF ADOPTION
, a minor.
On the
day of
,
, a Decree of Adoption was
signed by a judge of the the adoption of the records in the
County Court and entered of record in the matter of , which appears as Case Number County Court. of
Date:
By the Court: (Clerk)