Service Return {CC-3-21}

IN THE COUNTY COURT OF COUNTY, NEBRASKA Plaintiff vs. Defendant Case SERVICE RETURN To: County Court, , , Nebraska . (address) (city) (ZIP code) eceived this on the day . I hereby certify that on the day of , 20 , at of , 20 approximately o'clock .m., I served copies of the upon the party, , by as required by Nebraska state law. Service and return $ Copy $ Mileage miles $ TOTAL $ Date: By: Nebraska State Court Form SERVICE RETURN CC 3:21Document # American LegalNet, Inc. www.FormsWorkFlow.com