Nebraska State Court Form REQUIRED

AFFIDAVIT OF SEX OFFENDER REGISTRY SEARCHCC 16:2.30 Rev. 01/15

Neb. Ct. R. § 6-1449(A)(1)

Page 1 of 1 Affidavit of Sex Offender Registry Search CC 16:2.30 Rev. 01/2015

CASE No. _________________________ IN THE MATTER OF

AFFIDAVIT OF SEX OFFENDER REGISTRY SEARCH _______________________________

Ward/Protected Person/ Incapacitated Person

I, _______________________________ , swear that I have completed the online search of the Nebraska

Sex Offender Registry for the proposed guardian or conservator as shown by the attached printouts of the

search page and results.

Date Signature

Name

Bar Number and Firm Name (attorneys only)

Street Address/P.O. Box

City/State/ZIP Code

Phone E-mail Address

State of ) ) ss.

County of )

The foregoing instrument was acknowledged before me by , this Name

day of , . Day Month Year

Notary Public (Signature of Person Taking Acknowledgment)

(Serial Number, if any) (Title or Rank)

My commission expires: