Preview
Nebraska State Court Form REQUIRED
DC 19:29 Rev, 01/2020
Neb. Rev. Stat. § 28-311.11
IN THE DISTRICT COURT OF PHELPS COUNTY, NEBRASKA
Kotla Orin , Case No. OV 34-a?
ofb/o: J Petitioner,
PETITION AND AFFIDAVIT
(if you are filing this Petition for another person or TO OBTAIN SEXUAL
minor child who cannot file for themselves, then ASSAULT PROTECTION
enter their name on this line)
FILED
ORDER
‘Rebect . Sleter MAR 08 2024
Respondent.
JENNIFER L. NELSON
STRI
K OF Dit
PHELPS Co) a COURT
1 alan Orein, , am petitioning for a sexual
assault phalection order pursuant to Neb. Rev. Stat. § 28-311.11. Iam filing this
petition on behalf of myself. I have been a victim of sexual assault. My
relationship to the respondent is: _CO -Wwocie>
tam 19 or older or legallyemancipated. OR [] I am a minor and
years of age.
D Ido not speak English. The language that I speak is:
OR
lam petitioning for a sexual assault protection order pursuant to Neb. Rev.
Stat. § 28-311.11 on behalfof who
1S. years of age, has been a victim of sexual assault, and whose
name is shown after mine in the caption of this petition. My relationship to the
party seeking protection is:
custodial parent.
D guardian.
(other:
{you must specify the relationship)
0 The person seeking protection does not speak English.
The language spoken is:
The relationship of the party seeking protection to the respondent is:
DC 19:29 Rev. 01/2020 Page 1 of 5
wn
2. Check Only One:
0 I have received address protection from the Secretary of State under the
Address Confidentiality Program.(Service of any court process shall be made by
mailing two copies of the process to the Office of Secretary of State, Address
Confidentiality Program, Suite 2300, State Capitol Building, Lincoln, NE, 68509)
Olam living at a safe house or shelter for my own protection. Pursuant to Neb.
Rev. Stat. § 29-4303, I cannot identify the name, address, location or phone number
of the facility.
ia’My address is:
SID WwW Ave. Holdreae. NE ESI
(Street or Route/Box) (City) (State) (ZIP code)
Mailing address (if different):
B Awest Ve Ho Idrec c. NE 6394
(Street or Roite/Box) (City) (State) (ZIP code)
3. Neb. Ct. Rule § 2-208 requires people involved in a case who are not attorneys
to provide their email address or provide a reason why they cannot receive emails.
1 Ido not have the ability to receive emails, The reason I cannot receive email is:
[My email address is: kail
NOTE: By providing this email address, I acknowledge that I am aware that
this information will be public record. I also understand that I will only receive
email communications regarding this case from the court.
4. I am filing this petition against the respondent whose age is:__@2>__and who
resides at:
\a4l Go rot St Hal dreae NE Ggqy9
(Street or Route/Box) (City) (State) (ZIP code)
Mailing address (if different):
(Street or Route/Box) (City) (State) (ZIP code)
(Phone number)
OO The respondent does not speak English. The language that the respondent speaks is:
5 . The respondentis a person who has willfully committed acts of sexual assault as defined
in Neb. Rev. Stat. §§ 28-318 to 28-320.01 against.
(name of the person seeking protection)
Petition and Affidavit for
DC 19:29 Rev, 01/2020 Page 2 of 5 Sexual Assault Protection Order
6. To my knowledge, the ondent and Tor 1 the person seeking
protection] have or have not been involved in past or current court cases
together. (i.e., divorce, paternity, custody, juvenile, criminal or protection
orders) If so: when, where, type of case, name of court(s), and case number(s).
7. Ihereby ask the court to enter a protection order (mark all that apply):
rohibiting the respondent from imposing anyrestraint upon the person
seeking protection.
prohibiting the respondent from harassing, threatening, assaulting,
molesting, attacking, or otherwise disturbing the peace of the person
we
eeking protection.
‘prohibitingthe respondent from telephoning, contacting, or otherwise
communicating with the person seeking protection.
8. Pursuant
to Neb, Rev, Stat. § 25-2740, I request to have a aise
Court
Judge, County Court Judge preside over this proceeding. (I understand this request
may not be granted.)
9. The date(s) or approximate date(s) and event(s) and the most severe incident
or incident(s) of sexual assault toward the person seeking protection was/were:
(Please write a brief but detailed description.)
a. Date/Time:Thursdoia NMarela 2024 2 S8_,Pescription
While. {Hine down doing ato. Mm the breale OVE ,
bel
shict colloc sauna he Wx« Cicines She toc, We ein
move hi hends fn mu _Shald3z soutrio, Shot ive
ate aicl exore Siidiiac, Les les
Zh ren’
hols dea We oock and beow "Cust to sy
an i tania jaeck Gece I clacd yecoedine, On Wir
hone shana“ yo cw Sou Mais is raat alc fae He_awals
attr srl dens oegalin c. mM Gnd Keen re A
vere wok Tull CAS Cass ey xc dont want thi
He OL), bell Shrus Phe G God Fibre Gc hot
is Bowats, O ‘all ees potie own, TC kee reiting, and he
dries > Feath for eae! bot I step
ep Awan, te stops only
ater Xr tell hie F will ap act ancthee worker
Petition and Affidavit for
DC 19:29 Rev. 01/2020 Page 3 of 5 Sexual Assault Protection Order
b. (fneeded) Date/Time: Fel, ~ Mach 2024 Description:
beCcre. fhe main incident ptheve Were Leow dimes
he woud arab tru orn an
we Foy on Www vail something act_oub attention
'
L Wn OVS of
aoue ne some povre but didet ta fe dwi Al
1 ish
behave
c. ([fneeded) Date/Time Description:
10. I request the court treat this Petition and Affidavit for a Sexual
Assault Protection Order as a request for a domestic abuse protection order or
a harassment protection order if it appears to the court, based on facts
contained in this Petition and Affidavit and the evidence presented at a show
cause hearing, that another type of protection order is more appropriate in
this case, and the court makes such findings.
Petition and Affidavit for
DC 19:29 Rev. 01/2020 Page
4 of 5 Sexual Assault Protection Order
Thereby swear, or affirm, under penalty of perjury, the foregoing affidavit is true.
| | '
Alrs
ie ‘irm name, and Bar Number IF bei leted by an attorney)
(do NOT sign UNTIL THE CLERK OF THE DISTRICT COURT ORA
NOTARY IS PRESENT AND WITNESSES YOU SIGNING)
State of Neloraskes )
)ss.
County of, Roclos )
te document was wot WNC
before meme wy ad gb lu Al Yai Nn :
Buen
on
“eye Notary commission expires:
Ona
Signatare-oftudge/Clerk of the Court/Notaa-Rublic
Title: Serial Number (if any)
Once filed, a petition for a sexual assault protection order may not be
withdrawn except upon order of the court.
Petition and Affidavit for
DC 19:29 Rev. 01/2020 Page Sof S Sexual Assault Protection Order
Preview
Nebraska State Court Form REQUIRED DC 19:29 Rev, 01/2020 Neb. Rev. Stat. § 28-311.11 IN THE DISTRICT COURT OF PHELPS COUNTY, NEBRASKA Kotla Orin , Case No. OV 34-a? ofb/o: J Petitioner, PETITION AND AFFIDAVIT (if you are filing this Petition for another person or TO OBTAIN SEXUAL minor child who cannot file for themselves, then ASSAULT PROTECTION enter their name on this line) FILED ORDER ‘Rebect . Sleter MAR 08 2024 Respondent. JENNIFER L. NELSON STRI K OF Dit PHELPS Co) a COURT 1 alan Orein, , am petitioning for a sexual assault phalection order pursuant to Neb. Rev. Stat. § 28-311.11. Iam filing this petition on behalf of myself. I have been a victim of sexual assault. My relationship to the respondent is: _CO -Wwocie> tam 19 or older or legallyemancipated. OR [] I am a minor and years of age. D Ido not speak English. The language that I speak is: OR lam petitioning for a sexual assault protection order pursuant to Neb. Rev. Stat. § 28-311.11 on behalfof who 1S. years of age, has been a victim of sexual assault, and whose name is shown after mine in the caption of this petition. My relationship to the party seeking protection is: custodial parent. D guardian. (other: {you must specify the relationship) 0 The person seeking protection does not speak English. The language spoken is: The relationship of the party seeking protection to the respondent is: DC 19:29 Rev. 01/2020 Page 1 of 5 wn 2. Check Only One: 0 I have received address protection from the Secretary of State under the Address Confidentiality Program.(Service of any court process shall be made by mailing two copies of the process to the Office of Secretary of State, Address Confidentiality Program, Suite 2300, State Capitol Building, Lincoln, NE, 68509) Olam living at a safe house or shelter for my own protection. Pursuant to Neb. Rev. Stat. § 29-4303, I cannot identify the name, address, location or phone number of the facility. ia’My address is: SID WwW Ave. Holdreae. NE ESI (Street or Route/Box) (City) (State) (ZIP code) Mailing address (if different): B Awest Ve Ho Idrec c. NE 6394 (Street or Roite/Box) (City) (State) (ZIP code) 3. Neb. Ct. Rule § 2-208 requires people involved in a case who are not attorneys to provide their email address or provide a reason why they cannot receive emails. 1 Ido not have the ability to receive emails, The reason I cannot receive email is: [My email address is: kail NOTE: By providing this email address, I acknowledge that I am aware that this information will be public record. I also understand that I will only receive email communications regarding this case from the court. 4. I am filing this petition against the respondent whose age is:__@2>__and who resides at: \a4l Go rot St Hal dreae NE Ggqy9 (Street or Route/Box) (City) (State) (ZIP code) Mailing address (if different): (Street or Route/Box) (City) (State) (ZIP code) (Phone number) OO The respondent does not speak English. The language that the respondent speaks is: 5 . The respondentis a person who has willfully committed acts of sexual assault as defined in Neb. Rev. Stat. §§ 28-318 to 28-320.01 against. (name of the person seeking protection) Petition and Affidavit for DC 19:29 Rev, 01/2020 Page 2 of 5 Sexual Assault Protection Order 6. To my knowledge, the ondent and Tor 1 the person seeking protection] have or have not been involved in past or current court cases together. (i.e., divorce, paternity, custody, juvenile, criminal or protection orders) If so: when, where, type of case, name of court(s), and case number(s). 7. Ihereby ask the court to enter a protection order (mark all that apply): rohibiting the respondent from imposing anyrestraint upon the person seeking protection. prohibiting the respondent from harassing, threatening, assaulting, molesting, attacking, or otherwise disturbing the peace of the person we eeking protection. ‘prohibitingthe respondent from telephoning, contacting, or otherwise communicating with the person seeking protection. 8. Pursuant to Neb, Rev, Stat. § 25-2740, I request to have a aise Court Judge, County Court Judge preside over this proceeding. (I understand this request may not be granted.) 9. The date(s) or approximate date(s) and event(s) and the most severe incident or incident(s) of sexual assault toward the person seeking protection was/were: (Please write a brief but detailed description.) a. Date/Time:Thursdoia NMarela 2024 2 S8_,Pescription While. {Hine down doing ato. Mm the breale OVE , bel shict colloc sauna he Wx« Cicines She toc, We ein move hi hends fn mu _Shald3z soutrio, Shot ive ate aicl exore Siidiiac, Les les Zh ren’ hols dea We oock and beow "Cust to sy an i tania jaeck Gece I clacd yecoedine, On Wir hone shana“ yo cw Sou Mais is raat alc fae He_awals attr srl dens oegalin c. mM Gnd Keen re A vere wok Tull CAS Cass ey xc dont want thi He OL), bell Shrus Phe G God Fibre Gc hot is Bowats, O ‘all ees potie own, TC kee reiting, and he dries > Feath for eae! bot I step ep Awan, te stops only ater Xr tell hie F will ap act ancthee worker Petition and Affidavit for DC 19:29 Rev. 01/2020 Page 3 of 5 Sexual Assault Protection Order b. (fneeded) Date/Time: Fel, ~ Mach 2024 Description: beCcre. fhe main incident ptheve Were Leow dimes he woud arab tru orn an we Foy on Www vail something act_oub attention ' L Wn OVS of aoue ne some povre but didet ta fe dwi Al 1 ish behave c. ([fneeded) Date/Time Description: 10. I request the court treat this Petition and Affidavit for a Sexual Assault Protection Order as a request for a domestic abuse protection order or a harassment protection order if it appears to the court, based on facts contained in this Petition and Affidavit and the evidence presented at a show cause hearing, that another type of protection order is more appropriate in this case, and the court makes such findings. Petition and Affidavit for DC 19:29 Rev. 01/2020 Page 4 of 5 Sexual Assault Protection Order Thereby swear, or affirm, under penalty of perjury, the foregoing affidavit is true. | | ' Alrs ie ‘irm name, and Bar Number IF bei leted by an attorney) (do NOT sign UNTIL THE CLERK OF THE DISTRICT COURT ORA NOTARY IS PRESENT AND WITNESSES YOU SIGNING) State of Neloraskes ) )ss. County of, Roclos ) te document was wot WNC before meme wy ad gb lu Al Yai Nn : Buen on “eye Notary commission expires: Ona Signatare-oftudge/Clerk of the Court/Notaa-Rublic Title: Serial Number (if any) Once filed, a petition for a sexual assault protection order may not be withdrawn except upon order of the court. Petition and Affidavit for DC 19:29 Rev. 01/2020 Page Sof S Sexual Assault Protection Order