NEBRASKA STATE COURT
GENERAL CIVIL CASE COVER SHEET
[// GUIDANCE: File this Cover Sheet together with the initial Complaint/Petition. Submit one completed Cover Sheet per case. Keep a copy for your records.]
I. COURT & CASE IDENTIFICATION
- Jurisdiction: ☐ District Court ☐ County Court
- County: ______
- Case No. (Clerk use only): ________
- Judge (if known/assigned): _______
II. PARTY INFORMATION
| Role | Full Legal Name | Address | City/State/ZIP | Phone | Self-Represented? | Attorney of Record (if any) | Bar No. | |
|---|---|---|---|---|---|---|---|---|
| Plaintiff | [PLAINTIFF NAME] | [ADDRESS] | ☐ | [LAW FIRM / ATTY NAME] | ||||
| Defendant | [DEFENDANT NAME] | [ADDRESS] | ☐ | [LAW FIRM / ATTY NAME] | ||||
| Additional Parties (attach sheet if necessary) |
[// GUIDANCE: For multiple plaintiffs/defendants attach “Addendum to Party Information.”]
III. CASE CATEGORY (Check ONE primary category; mark sub-type as applicable)
A. CONTRACT
⬜ 01. Written Contract ⬜ 02. Oral Contract ⬜ 03. U.C.C. ⬜ 04. Insurance
B. REAL PROPERTY
⬜ 05. Foreclosure ⬜ 06. Quiet Title ⬜ 07. Eminent Domain ⬜ 08. Landlord/Tenant
C. TORT
⬜ 09. Motor Vehicle ⬜ 10. Premises Liability ⬜ 11. Products Liability ⬜ 12. Medical Malpractice
⬜ 13. Wrongful Death ⬜ 14. Personal Injury—Other
D. EMPLOYMENT
⬜ 15. Discrimination ⬜ 16. Wage & Hour ⬜ 17. Other Employment
E. CIVIL RIGHTS
⬜ 18. § 1983/Constitutional ⬜ 19. Other Civil Rights
F. OTHER STATUTORY/REGULATORY
⬜ 20. Administrative Appeal ⬜ 21. Tax ⬜ 22. Declaratory Judgment ⬜ 23. Injunction
G. MISCELLANEOUS
⬜ 24. Professional License ⬜ 25. Trust/Probate ⬜ 26. Misc. Civil (specify): ___
IV. RELATED CASES
-
Are there any related cases pending in Nebraska state or federal courts?
☐ Yes ☐ No
If “Yes,” list court, case number, and judge: ________ -
Previous dismissed/terminated actions involving substantially the same parties or claims?
☐ Yes ☐ No
If “Yes,” provide details: _________
V. AMOUNT IN CONTROVERSY & FILING FEE CALCULATION
- Monetary Relief Sought: $ ________ (exclusive of fees, interest, & costs)
- Non-Monetary Relief (describe, e.g., injunction): _______
- Statutory Filing Fee: $ [CURRENT DOCKET FEE]*
- Additional Fees (summons issuance, jury demand, etc.): $ _____
- Total Remitted: $ ________
[// GUIDANCE: Nebraska docket fees are set by statute and Supreme Court rule and change periodically. Verify the current amount with the Clerk’s office or the latest Nebraska Judicial Branch fee schedule on the date of filing*.]
VI. SERVICE INFORMATION
- Method(s) of Service Requested (check all that apply):
☐ Personal ☐ Certified Mail ☐ Designated Delivery Service ☐ Publication ☐ Voluntary Appearance - Special Process Server Requested? ☐ Yes ☐ No
If “Yes,” name: ________
VII. JURY DEMAND
☐ Jury Trial Demanded ☐ No Jury Requested
[// GUIDANCE: A separate written jury demand and statutory fee must be filed/paid within the time limits set by Neb. Ct. R. Civ. P., if not demanded in the Complaint.]
VIII. SPECIAL STATUTORY REQUIREMENTS (if applicable)
☐ Venue Affidavit attached ☐ Medical Malpractice Review Panel Certificate attached
☐ Notice of Tort Claim compliance alleged ☐ Other statutory pre-conditions satisfied
[// GUIDANCE: Mark and attach any statutorily-required certifications, notices, or affidavits.]
IX. ATTORNEY/SELF-REPRESENTED PARTY CERTIFICATION
I certify that (i) the information provided in this Cover Sheet is true and correct to the best of my knowledge; (ii) this Sheet is filed in compliance with Nebraska Supreme Court rules; and (iii) a copy will be served on all parties together with the initiating pleading.
| Signature | Date | Printed Name | Bar Number (if any) |
|---|---|---|---|
| _______ | ____ | _________ | ____ |
FILING REQUIREMENTS CHECKLIST
☐ Complaint/Petition signed & dated
☐ This Civil Case Cover Sheet completed & signed
☐ Filing fee(s) enclosed (check or authorized electronic payment)
☐ Summons forms prepared (if applicable)
☐ Required statutory certifications/affidavits attached
☐ Additional party addendum (if >2 plaintiffs or defendants)
☐ Electronic filing conventions followed (if e-filed)
[// GUIDANCE: Courts may reject pleadings that are incomplete, unsigned, or submitted without the correct fee. Double-check all attachments before submission.]
IMPORTANT NOTICES
- Public Record: Documents filed become part of the public court record unless sealed by order.
- Sensitive Data: Redact Social Security numbers, financial account numbers, and other personal identifiers in compliance with Nebraska Court rules on privacy.
- Updates: Filing fees, case category designations, and procedural requirements are subject to change. Always consult the most recent Nebraska statutes, Supreme Court rules, and local court administrative orders.
[// GUIDANCE: This template is provided for general informational purposes and must be reviewed and tailored by a licensed Nebraska attorney prior to use. Do not rely exclusively on this form without confirming current procedural rules and statutory requirements.]