General Civil Case Cover Sheet

NEBRASKA STATE COURT

GENERAL CIVIL CASE COVER SHEET

Required Filing: This Cover Sheet must be submitted with every complaint, petition, or other document initiating a civil action in Nebraska District Court or County Court. See Neb. Ct. R. § 6-1104. Submit one completed Cover Sheet per case. Retain a conformed copy for your records.

I. COURT AND CASE IDENTIFICATION

1. Court Level:

☐ District Court
☐ County Court

2. County: [________________________________]

3. Case Number (Clerk Use Only): [________________________________]

4. Assigned Judge (if known or assigned): [________________________________]

5. Filing Date: [__/__/____]

6. Related Case Number(s) (if any): [________________________________]

II. PARTY INFORMATION

A. Plaintiff(s) / Petitioner(s)

B. Defendant(s) / Respondent(s)

☐ Additional parties listed on attached addendum sheet.

C. Attorney Information (Filing Party)

Pursuant to Neb. Ct. R. § 6-1503, the name, address, Nebraska attorney identification number, email address, and telephone number of the attorney handling the matter must be stated on each pleading.

III. CASE CATEGORY

Instructions: Check ONE primary category. Mark the applicable sub-type within that category. Accurate case coding is required for proper docketing by the Clerk.

A. CONTRACT

☐ 01 — Written Contract
☐ 02 — Oral Contract
☐ 03 — Uniform Commercial Code (U.C.C.) (Neb. U.C.C. § 2-101 et seq.)
☐ 04 — Insurance Coverage / Bad Faith
☐ 05 — Promissory Note / Negotiable Instrument
☐ 06 — Debt Collection (Neb. Rev. Stat. § 25-205 et seq.)
☐ 07 — Construction Contract
☐ 08 — Other Contract: [________________________________]

B. REAL PROPERTY

☐ 09 — Mortgage Foreclosure (Neb. Rev. Stat. § 25-2137 et seq.)
☐ 10 — Quiet Title (Neb. Rev. Stat. § 25-21,112)
☐ 11 — Eminent Domain / Condemnation (Neb. Rev. Stat. § 76-704 et seq.)
☐ 12 — Landlord/Tenant – Eviction (Neb. Rev. Stat. § 76-1401 et seq. – Uniform Residential Landlord and Tenant Act)
☐ 13 — Partition
☐ 14 — Boundary / Easement Dispute
☐ 15 — Mechanic's Lien (Neb. Rev. Stat. § 52-101 et seq.)
☐ 16 — Other Real Property: [________________________________]

C. TORT

☐ 17 — Motor Vehicle Accident
☐ 18 — Premises Liability
☐ 19 — Products Liability (Neb. Rev. Stat. § 25-21,180 et seq.)
☐ 20 — Medical Malpractice (Nebraska Hospital-Medical Liability Act, Neb. Rev. Stat. § 44-2801 et seq.)
☐ 21 — Legal Malpractice
☐ 22 — Wrongful Death (Neb. Rev. Stat. § 30-809 et seq.)
☐ 23 — Personal Injury — Other
☐ 24 — Defamation / Libel / Slander
☐ 25 — Fraud / Misrepresentation
☐ 26 — Other Tort: [________________________________]

D. EMPLOYMENT

☐ 27 — Employment Discrimination (Nebraska Fair Employment Practice Act, Neb. Rev. Stat. § 48-1101 et seq.)
☐ 28 — Wage and Hour Dispute (Neb. Rev. Stat. § 48-1228 et seq. – Nebraska Wage Payment and Collection Act)
☐ 29 — Workers' Compensation Appeal (Neb. Rev. Stat. § 48-101 et seq.)
☐ 30 — Wrongful Termination
☐ 31 — Other Employment: [________________________________]

E. CIVIL RIGHTS

☐ 32 — 42 U.S.C. § 1983 / Constitutional Violation
☐ 33 — State Civil Rights (Neb. Rev. Stat. § 20-148 et seq.)
☐ 34 — Other Civil Rights: [________________________________]

F. OTHER STATUTORY / REGULATORY

☐ 35 — Administrative Agency Appeal (Neb. Rev. Stat. § 84-917 – Administrative Procedure Act)
☐ 36 — Tax Appeal
☐ 37 — Declaratory Judgment (Neb. Rev. Stat. § 25-21,149 et seq. – Uniform Declaratory Judgments Act)
☐ 38 — Injunction / Temporary Restraining Order
☐ 39 — Claim of Unconstitutionality (must also check box in Section VIII)
☐ 40 — Other Statutory: [________________________________]

G. MISCELLANEOUS

☐ 41 — Interpleader
☐ 42 — Trust Dispute
☐ 43 — Guardianship / Conservatorship (Neb. Rev. Stat. § 30-2601 et seq.)
☐ 44 — Estate / Probate Matter
☐ 45 — Professional License Dispute
☐ 46 — Replevin (Neb. Rev. Stat. § 25-10,101 et seq.)
☐ 47 — Habeas Corpus
☐ 48 — Miscellaneous Civil (specify): [________________________________]

IV. RELATED CASES

1. Are there any related cases pending in any Nebraska state or federal court?

☐ Yes ☐ No

If "Yes," provide the following for each related case:

2. Have any previous actions involving substantially the same parties or claims been dismissed, terminated, or consolidated?

☐ Yes ☐ No

If "Yes," provide details: [________________________________]

V. AMOUNT IN CONTROVERSY AND FILING FEE CALCULATION

1. Monetary Relief Sought:

☐ $0 – $1,800 (Small Claims Division only)
☐ $1,801 – $15,000
☐ $15,001 – $53,000 (County Court jurisdictional limit)
☐ $53,001 – $100,000
☐ $100,001 – $500,000
☐ Over $500,000
☐ Amount unspecified / to be determined

Specific Amount Claimed (if known): $[________________________________] (exclusive of interest, fees, and costs)

2. Non-Monetary Relief Sought (describe): [________________________________]

3. Filing Fee Calculation:

Method of Payment:
☐ Check payable to "Clerk of the District Court"
☐ Cash
☐ Credit/Debit Card
☐ Electronic payment (for e-filed cases)

Note: Filing fees are set by Neb. Rev. Stat. § 33-103 (District Court) and § 33-106 (County Court) and are subject to change. Verify the current fee schedule with the Clerk's office or the Nebraska Judicial Branch website before filing.

VI. SERVICE INFORMATION

1. Method(s) of Service Requested (check all that apply):

☐ Personal service by sheriff or authorized process server (Neb. Rev. Stat. § 25-505.01)
☐ Certified mail, return receipt requested (Neb. Rev. Stat. § 25-505.01)
☐ Designated delivery service (Neb. Rev. Stat. § 25-505.01)
☐ Voluntary appearance / acceptance of service (Neb. Rev. Stat. § 25-516)
☐ Service by publication (Neb. Rev. Stat. § 25-517; § 25-520.01)
☐ Service on Secretary of State for nonresident motorist (Neb. Rev. Stat. § 25-530)
☐ Service on registered agent (Neb. Rev. Stat. § 25-506)
☐ Other authorized method: [________________________________]

2. Special Process Server Requested?

☐ Yes — Name of process server: [________________________________]
☐ No

3. Number of Summonses to be Issued: [____]

VII. JURY DEMAND

☐ Jury trial is demanded at this time. The jury demand fee is enclosed or will be paid electronically.

☐ No jury trial is demanded at this time.

Note: If a jury trial is not demanded in the complaint or petition, a separate written jury demand must be filed and the statutory jury fee must be paid within the time limits prescribed by Nebraska rules. See Neb. Rev. Stat. § 25-1103.

VIII. SPECIAL STATUTORY REQUIREMENTS

Check all that apply:

☐ Claim of Unconstitutionality: This action challenges the constitutionality of an act of Congress or a Nebraska statute. (Notification is required on the cover sheet or in the caption of the pleading.)

☐ Medical Malpractice Review Panel: A medical review panel opinion has been obtained as required by the Nebraska Hospital-Medical Liability Act, Neb. Rev. Stat. § 44-2840 et seq. Certificate attached.

☐ Venue Affidavit: Venue affidavit is attached as required by Neb. Rev. Stat. § 25-410 (actions against Nebraska political subdivisions).

☐ Notice of Tort Claim Compliance: The filing party has complied with the notice requirements of the Nebraska Political Subdivisions Tort Claims Act, Neb. Rev. Stat. § 13-905, or the State Tort Claims Act, Neb. Rev. Stat. § 81-8,213.

☐ Lis Pendens Filed: A notice of lis pendens has been filed in the appropriate county pursuant to Neb. Rev. Stat. § 25-531.

☐ Verified Petition Required: The petition is verified as required by applicable statute.

☐ Other Statutory Pre-Conditions Satisfied: [________________________________]

☐ None of the above apply.

IX. ATTORNEY / SELF-REPRESENTED PARTY CERTIFICATION

I hereby certify that:

(i) The information provided in this Civil Case Cover Sheet is true and correct to the best of my knowledge, information, and belief;

(ii) This Cover Sheet is filed in compliance with the Nebraska Supreme Court Rules, including Neb. Ct. R. § 6-1104;

(iii) A copy of this Cover Sheet will be served upon all parties together with the initiating pleading;

(iv) I have complied with the requirements of Neb. Ct. R. § 6-1503 regarding pleading format and content; and

(v) I have verified the current filing fee schedule and remitted the correct amount.

Signature: ________________________________________

Printed Name: [________________________________]

Nebraska Attorney ID No. (if applicable): [________________________________]

Date: [__/__/____]

X. FILING REQUIREMENTS CHECKLIST

Before submitting this Cover Sheet and initiating pleading, confirm completion of all applicable items:

☐ Complaint / Petition is signed and dated

☐ This Civil Case Cover Sheet is completed and signed

☐ Filing fee(s) are enclosed or paid electronically (verify current amounts)

☐ Summons form(s) are prepared (one per defendant, if applicable)

☐ Required statutory certifications or affidavits are attached (medical review panel, venue affidavit, tort claim notice, etc.)

☐ Additional party addendum is attached (if more than 3 plaintiffs or defendants)

☐ All pleadings comply with Neb. Ct. R. § 6-1503 formatting requirements:

• White 8.5" x 11" paper (if paper-filed)
• Printed on one side only (if paper-filed)
• Bound by paper clip, not stapled (if paper-filed)
• Complies with Neb. Ct. R. App. P. § 2-103 (if e-filed)

☐ Personal identifying information has been redacted pursuant to Nebraska Court rules on privacy

☐ Electronic filing conventions are followed (if e-filed through Nebraska E-Filing system)

☐ Copy retained for filing party's records

IMPORTANT NOTICES

1. Public Record. Documents filed with the court become part of the public court record unless sealed by court order. Sensitive information should be redacted or filed under seal where permitted.

2. Sensitive Data. Pursuant to Nebraska Supreme Court rules on privacy, redact Social Security numbers, financial account numbers, dates of birth (except year), and names of minor children from all publicly filed documents.

3. Fee Schedule Changes. Filing fees, docket fees, and associated costs are set by statute and Supreme Court rule and are subject to periodic change. Always verify the current fee schedule with the Clerk of the Court or at the Nebraska Judicial Branch website before filing.

4. Rejection. Courts may reject pleadings that are incomplete, unsigned, unaccompanied by the correct filing fee, or that fail to include required attachments such as this Cover Sheet. Incomplete filings may result in delayed docketing.

5. E-Filing. Nebraska courts have transitioned to electronic filing. Confirm e-filing requirements and procedures with the applicable court.

FOR CLERK'S USE ONLY — DO NOT WRITE BELOW THIS LINE

Sources and References

• Neb. Rev. Stat. § 25-501: Commencement of Civil Action
• Neb. Rev. Stat. § 25-502: Filing of Petition
• Neb. Rev. Stat. § 25-505.01: Service of Process Methods
• Neb. Rev. Stat. § 25-517: Service by Publication
• Neb. Rev. Stat. § 25-520.01: Requirements for Publication Service
• Neb. Rev. Stat. § 33-103: District Court Docket Fees
• Neb. Rev. Stat. § 33-106: County Court Fees
• Neb. Ct. R. § 6-1104: Civil Cover Sheet Requirement
• Neb. Ct. R. § 6-1503: Pleadings Format and Requirements
• Neb. Ct. R. App. P. § 2-103: General Formatting and Service Rules (E-Filing)
• Nebraska Judicial Branch – Filing Fees and Court Costs: https://nebraskajudicial.gov/rules/administrative-policies-schedules/filing-fees-and-court-costs
• Nebraska Judicial Branch – Self-Help Resources: https://nebraskajudicial.gov/self-help
• Nebraska Legislature – Revised Statutes Chapter 25: https://nebraskalegislature.gov/laws/browse-chapters.php?chapter=25