Nebraska > Local County > 3rd District
Receipt For Specific Amount - Nebraska
| Receipt For Specific Amount Form. This is a Nebraska form and can be used in 3rd District Local County . |
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IN THE DISTRICT COURT OF LANCASTER COUNTY, NEBRASKA (575 S. 10th Lincoln, NE 68508) RECEIPT FOR SPECIFIC AMOUNT CASE NUMBER _________________________ CASE TITLE _____________________________ vs ____________________________ I hereby receipt the amount of $__________for: _____________________________________________ (Child Support, Child Care, Spousal Support, Property Settlement) from _____________________________on this _________ day of ____________________, 20______ (Payor's Name) (Date to Credit Account) The State of Nebraska will only accept non-monetary receipts for amounts which are equal-to or less-than the amount owing on the credit date. If no amount is owing, no credit will or may be given. I understand that no credit will be given if there is a lien filed by any state agency or if I am currently receiving ADC from the State. The CLERK OF THE DISTRICT COURT accepts no responsibility for the content of this notarized receipt. If you have any questions please contact your attorney. ________________________________________ Print Your Name __________________________________________ Your Address __________________________________________________________ City, State, Zip _______________________________ Phone Number _______________________________________________ Signature (Sign in the Presence of a Notary Public) SUBSCRIBED AND SWORN TO BEFORE ME ON THIS ________DAY OF __________________, 20_______ ________________________________________________ American LegalNet, Inc. www.FormsWorkflow.com
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