Preview
Nebraska State Court Form
REQUIRED
PETITION AND AFFIDAVIT TO SAP YCs Ity
dle
OBTAIN HARASSMENT vue
DC19:2 Rev. 01/2020
PROTECTION ORDER 2024 APR 10 AMIN: 43
Neb. Rev. Stat.
§ 28-311.09
IN THE DISTRICT COURT OF COUNTY, NEBRASKA HIGT COURT
Lisa L Hellosel| Case No cI24 bir
Petitioner,
AN 24611730
\Additior Petitioner/Minor Child(ren),
PETITION AND AFFIDAVIT TO
Addition:
1
’etitioner/Minor Child(ren),
10. OBTAIN HARASSMENT PROTECTION
ORDER
vs.
0 S
Respondent.
.
1 U, | ALLOW , am the petitioner in this case. | am petitioning for a
harassment protection order pursuant to Neb. Rev. Stat. § 28-31 1.09.
lam filing this petition on behalf of:
a
Myself. | have been harassed.
Myself and additional petitioner(s) who have been harassed and whose name(s) is/are shown after mine in the
caption of this petition. My relationship to the additional petitioner(s)/minor child(ren) is/are:[_]custodial parent,
Os guardian,LJ other:
o Only on behalf of the additional petitioner(s) wno have been harassed and whose name(s) is/are shown
after mine in the caption of this petition. My relationship to the additional Petitioner(s\minor child(ren) is/are:
custodial parent, guardian, other:
AND:
ss lam 19 or older or legally emancipated OR (0: ~|ama minor and years of age.
(1 | do not speak English. The language that | speak is:
2. Check Only One:
1) Ihave 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)
[O_ !am living at a safe house or shelterfor my own protection. Pursuant to Neb. Rev. Stat. §29-4303, | cannot
identify the name, address, location or phone number of the facility.
aU Vous DY
(Street
or Route/Box)
Bellevue(City)
Ne(State)
gx0o S
(ZIP code)
(1 Mailing address (if different):
Page 1 of 4 (Street
or Route/Box) (city) (State) (ZIP code)
Petition and Affidavit to Obtain
Harassment Protection Order
DC 19:2 Rev. 01/20
My
000816806
S
3. (1 !donotagreetoreceive notification by e-mail
Thallasellaa @mai). Com
w lagree toreceive
e-mail address:
NOTE: By providing this e-mail address, bat that th
public record, | also understand that | will only receive e-mail communications regarding this case
from the court.
| Os thisCk against the re: Or Bellen Joeis: 50
2 Ne who resides at: Uy XK 0 <
AMSAS DI
(Street
or Route/Box) (City) (State) (ZIP code)
Mailing address (if different)
(Street
or Route/Box) (City) (State) (ZIP code)
(Phone number)
1 The respondent does not speak English. The language that the respondent speaks is:
My relationship to the respondent is: Sian
The respondent is a person who has willfully harassed me and has engaged in a knowing and willful
course of conduct directed at me which seriously terrifies, threatens, or intimidates me and serves no
legitimate purpose.
To my knowledge, The respondent and | OD 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).
| hereby ask the court to enter a protection order (mark all that apply):
ik prohibiting the respondent from imposing any restraint upon the person(s) seeking protection.
prohibiting the respondent from harassing, threatening, assaulting, molesting, attacking,
otherwise disturbing the peace of the person(s) seeking protection.
prohibiting the respondent from telephoning, contacting, or otherwise communicating with the person(s)
seeking protection.
Pursuant to Neb. Rev. Stat. § 25-2740, | request to have a District Court Judge, or a PXCounty Court Judge
jot be yranted.).
preside over this proceeding.(I understand this request may not
The dates or approximate dates and facts of the most recent series of acts and the most severe incident or incident(s) of
harassment toward the person(s) seeking protection are (Please write a brief but detailed description.):
A. Date/Time: & Ythy Gao Description: Pola. aot iwolveA
” WL (
C
o
c
CW
— Yarn,
J
Page 2 of 4
Petition and Affidavit to Obtain
Harassment Protection Order Additional spaces to write your description(s) are on the next page.
DC 19:2 Rev. 01/20
B. Date/Ti ne Apc! 5 Zo Description: + unting, ML +
Sehabinds, Ahnsk md | du 4 thea
a) J (rl Ay
Statvd Warat At eth Pood naw Mar Vo tO wart
ny Hat Shut Qre bur An pater Ww naScpol —
OA) fing on Sdtorth ¥
C. Date/Time:, PP LOL Description: dsto ron Place,
WC Lod athor Shows Wie COMOANA tops. fig. Awd
C Ove Str _}f iDwsiAy COs
heavy Was omoknmn Wred ¥ nnEny
Di vt yo au oan SQSS- MQ. POL n
eon Goheet
fh qj NIP Et
DOAN VOSS 21
OV At Oty ATO
+H HE 6 ks 2 harrsoent forthe fasP
10.
2 ave\ Walt \e "G
| request the court treat this Petition and Affidavit
for a
wen No ave wadlPe {0 Hsien 40 A
rassmen' tt Protection Order as a request for a sexual assault I~
ont |
Ww )
and
protection order or a domestic abuse protection order if it appears to the court, based on facts contained in this Petition
et
in this
Affidavit and the evidence presented at a show cause hearing, that another type of protection order is more appropriate
case, and the court makes such findings.
J of
41. Additional Petitioner(s) (if needed): Dn NLL
Petitioner 2 (Minor Child):
Name: Age: Relationship to the Respondent:
esi :
No atonSh
The address of this Petitioner is the same as my address above. Nevo hbouv—
oO This Petitioner's address is:
{Street or Route/Box) (Gis) (state) iP code)
Petitioner 3 (Minor Child):
Name: Age: Relationship to the Respondent:
Carlos hallosell 4b No YelatteSayp
Residence:
we The address of this Petitioner is the same as my address above.
Nalqhbor
oO This Petitioner's address is:
(iret or Route/Box) (cry) (State) GP code)
Page 3 of 4
Petition and Affidavit to Obtain Harassment Protection
Order DC 19:2 Rev. 01/20
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Petitioner 4 (Minor Child):
NO Pelabioshio
onal
Name: Age: Relationship to the Respondent: Gon
Sonesto Na 4 RE 1gn\oa
x
Residence:
The address of this Petitioner is the same as my address above.
a This Petitioner's address is:
{Street
or Route/Box) (Gv) (state) Gol
Petitioner 5 (Minor Child):
Name: Age: Relationship to the Respondent:
Residence:
Qo The address of this Petitioner is the same as my address above.
Oo This Petitioner's address is:
(Street or Route/Box) (Gy) (state) Gol
Petitioner 6 (Minor Child):
Name: Age: Relationship to the Respondent:
Residence:
o The address of this Petitioner is the same as my address above.
oO This Petitioner's address is:
(Street or Route/Box) (en) (state) ip)
| SS Nalocll of perjury, the foregoing affidavit is true.
Signature of Petitioner
(Name, Firm name, and Bar Number IF being completed by an attorney)
(do NOT sign UNTIL THE CLERK OF THE DISTRICT COURT OR A NOTARY IS PRESENT AND WITNESSES YOU SIGNING)
Subscribed and swom before me on April lo 20 24
Clerk of the CourtNtotary Publis (Seal)
My Commission Expires: Stateof
Page 4 of 4
Petition and Affidavit to Obtain
Harassment Protection Order
DC 19:2 Rev. 01/20
Preview
Nebraska State Court Form REQUIRED PETITION AND AFFIDAVIT TO SAP YCs Ity dle OBTAIN HARASSMENT vue DC19:2 Rev. 01/2020 PROTECTION ORDER 2024 APR 10 AMIN: 43 Neb. Rev. Stat. § 28-311.09 IN THE DISTRICT COURT OF COUNTY, NEBRASKA HIGT COURT Lisa L Hellosel| Case No cI24 bir Petitioner, AN 24611730 \Additior Petitioner/Minor Child(ren), PETITION AND AFFIDAVIT TO Addition: 1 ’etitioner/Minor Child(ren), 10. OBTAIN HARASSMENT PROTECTION ORDER vs. 0 S Respondent. . 1 U, | ALLOW , am the petitioner in this case. | am petitioning for a harassment protection order pursuant to Neb. Rev. Stat. § 28-31 1.09. lam filing this petition on behalf of: a Myself. | have been harassed. Myself and additional petitioner(s) who have been harassed and whose name(s) is/are shown after mine in the caption of this petition. My relationship to the additional petitioner(s)/minor child(ren) is/are:[_]custodial parent, Os guardian,LJ other: o Only on behalf of the additional petitioner(s) wno have been harassed and whose name(s) is/are shown after mine in the caption of this petition. My relationship to the additional Petitioner(s\minor child(ren) is/are: custodial parent, guardian, other: AND: ss lam 19 or older or legally emancipated OR (0: ~|ama minor and years of age. (1 | do not speak English. The language that | speak is: 2. Check Only One: 1) Ihave 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) [O_ !am living at a safe house or shelterfor my own protection. Pursuant to Neb. Rev. Stat. §29-4303, | cannot identify the name, address, location or phone number of the facility. aU Vous DY (Street or Route/Box) Bellevue(City) Ne(State) gx0o S (ZIP code) (1 Mailing address (if different): Page 1 of 4 (Street or Route/Box) (city) (State) (ZIP code) Petition and Affidavit to Obtain Harassment Protection Order DC 19:2 Rev. 01/20 My 000816806 S 3. (1 !donotagreetoreceive notification by e-mail Thallasellaa @mai). Com w lagree toreceive e-mail address: NOTE: By providing this e-mail address, bat that th public record, | also understand that | will only receive e-mail communications regarding this case from the court. | Os thisCk against the re: Or Bellen Joeis: 50 2 Ne who resides at: Uy XK 0 < AMSAS DI (Street or Route/Box) (City) (State) (ZIP code) Mailing address (if different) (Street or Route/Box) (City) (State) (ZIP code) (Phone number) 1 The respondent does not speak English. The language that the respondent speaks is: My relationship to the respondent is: Sian The respondent is a person who has willfully harassed me and has engaged in a knowing and willful course of conduct directed at me which seriously terrifies, threatens, or intimidates me and serves no legitimate purpose. To my knowledge, The respondent and | OD 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). | hereby ask the court to enter a protection order (mark all that apply): ik prohibiting the respondent from imposing any restraint upon the person(s) seeking protection. prohibiting the respondent from harassing, threatening, assaulting, molesting, attacking, otherwise disturbing the peace of the person(s) seeking protection. prohibiting the respondent from telephoning, contacting, or otherwise communicating with the person(s) seeking protection. Pursuant to Neb. Rev. Stat. § 25-2740, | request to have a District Court Judge, or a PXCounty Court Judge jot be yranted.). preside over this proceeding.(I understand this request may not The dates or approximate dates and facts of the most recent series of acts and the most severe incident or incident(s) of harassment toward the person(s) seeking protection are (Please write a brief but detailed description.): A. Date/Time: & Ythy Gao Description: Pola. aot iwolveA ” WL ( C o c CW — Yarn, J Page 2 of 4 Petition and Affidavit to Obtain Harassment Protection Order Additional spaces to write your description(s) are on the next page. DC 19:2 Rev. 01/20 B. Date/Ti ne Apc! 5 Zo Description: + unting, ML + Sehabinds, Ahnsk md | du 4 thea a) J (rl Ay Statvd Warat At eth Pood naw Mar Vo tO wart ny Hat Shut Qre bur An pater Ww naScpol — OA) fing on Sdtorth ¥ C. Date/Time:, PP LOL Description: dsto ron Place, WC Lod athor Shows Wie COMOANA tops. fig. Awd C Ove Str _}f iDwsiAy COs heavy Was omoknmn Wred ¥ nnEny Di vt yo au oan SQSS- MQ. POL n eon Goheet fh qj NIP Et DOAN VOSS 21 OV At Oty ATO +H HE 6 ks 2 harrsoent forthe fasP 10. 2 ave\ Walt \e "G | request the court treat this Petition and Affidavit for a wen No ave wadlPe {0 Hsien 40 A rassmen' tt Protection Order as a request for a sexual assault I~ ont | Ww ) and protection order or a domestic abuse protection order if it appears to the court, based on facts contained in this Petition et in this Affidavit and the evidence presented at a show cause hearing, that another type of protection order is more appropriate case, and the court makes such findings. J of 41. Additional Petitioner(s) (if needed): Dn NLL Petitioner 2 (Minor Child): Name: Age: Relationship to the Respondent: esi : No atonSh The address of this Petitioner is the same as my address above. Nevo hbouv— oO This Petitioner's address is: {Street or Route/Box) (Gis) (state) iP code) Petitioner 3 (Minor Child): Name: Age: Relationship to the Respondent: Carlos hallosell 4b No YelatteSayp Residence: we The address of this Petitioner is the same as my address above. Nalqhbor oO This Petitioner's address is: (iret or Route/Box) (cry) (State) GP code) Page 3 of 4 Petition and Affidavit to Obtain Harassment Protection Order DC 19:2 Rev. 01/20 i har Ware It Baud leyat WdvA ee tda ON6 i ps 9 me Mo that, whon a he Xs viet i a ng ee CAs aL“itt bare Spoke eng Poulin ts US wa be PyoliCes S Ben i Neyons fer he LS 2YRO" SINCg,stds x her Nason [Pisa Urs x Abt. dlawaly eo “et (And hor man wes Qhen mud, ONWd Hareetts a x Abe thom maken i e c Inv (ted So sated * hav Sis ter Qnd ko Ua, tn ‘Re +( | nny U oy Manltes x ComHpi by Hie OFC, Calloc? hier monk Never { q fp bey Wicond il, +S Bop Me eae we ii oh ol boy bac “sr we é ATPID OIE s U6 aganci a cae Wr r- nao ae WE aulted y binty Hy ho anitotne (NESS RB oe Nac! ace m INO W apt tn WAC Wy 0 oe scab ni98s ekons we had i wale pill vy neta oe we bdavd Bgth Ow No “at f Looe Shope n dnt have, CarPoe BAe bar we, AN mt RSpond Bacyl d, Ney Pade ©7145 Ihad Neer OPN Shorting dis nywator eA tt pur fOr ad ur wen Came, Nd Soe Disa Tt uss ost Oot bam na at i ra Soe Ayoked a ula 0 tt NAL wpe [tad at Sd OKOV) Foewri prove /Tig Dn rae ic suet b yi ne 6 lust f hale ‘ sR Sa WPF oner oh SoC ae Gan: ane. Kore x CPs vakae KFS OO Fyinnd x famy Shane * WUSbawel OE Khia oF Couman Xs Mayor Kthugtnef — Heong KS Ay. ety 16 534 State Prolie My roadhe “ta, ,* Comqressnon * EEbrsaH i X Lela ON Me to Hae A aia °° 25 X My ot} ML | Lauguoes, @ Me.| Kx 32 X SWin Laginy Cyonk Ob oles X Suddw Gorn ookgide ¢ Hein @ x Mrs oF Gorn XX 3s XFE peat Unvn rag Sag = 2 Xo peal XS ialiclCla0s 3 rs ot Mi © XPeportn fake PoporP 90 ML XD Pepi COM Caltmbern s relly. wk mt, \e Sen snowrtorinwy, IN canighog. ib: A a 0) feu bet wi Wore hare Pea RK sa a6 horkkK Prom we Hor a YLRLO (yn of He > Arog FAO Nt - 0 @48S pM 33 Neri 5 44s pm ig <3 a (LE_. Was ot Ms 8° 40 ‘oA i 4 3 rate AS Po Site 9 8 sa £5 2 Belch. Aw wots r gorn AY TF to a iMA ect ‘Spy gee Wh, TOY. Hunk sé ls nid Niger On 3 Ww LIVESwo) Nin tne, ue HISO hor aLet RK Black Ww\ Won = Siac x Au> And 4 ene wad, ORY. Fe eek cM Ant be rau! RIT val at hye. Aas MotRH ms haryas YAS aebs Lnvert+ my Ot Invi |ned\ gh Hine diana and ath sCetnpan Made taunts * ect han, Pople +y lean de dak M2 * he Psp mabre “Suse Sel of aat toAHic Qu ES when ho Pad ate Sr bat Heke sha i h AmLas Wo qe fu wer dig IN Come «W On nes oo Hari fo | ha ‘asa at Math Hat led Psdan) it LF Hut rele afina, MiHor > Ete "Pose kanal iis dining Wis Rd Vegla WAT WB wos, PU nd wasnt pee hite"| niin Ond nis aan (WAS gordi 7g fil fed [ae Plates (ABE DT (() Pres ist. Gav plates YF ode ») traps Is ocd lur Ci Vn in Sombr Haw crete WA were \ ie fails eae Qaten Kris ise ino isLi Lr har |epaetes CPs Calling e NL”te nit Chix 40 Hy Sie Waar WA wind ‘Ver Single * Diane marie Snow DA gt Vonsas Dir Blwve Ne lws ok pegond rite JM Kows Dr Bollev asve VE wos BOSH Linda Holler Sa Linda Wad Non hase Zt DH Horses De Rellwie ve Woas Petitioner 4 (Minor Child): NO Pelabioshio onal Name: Age: Relationship to the Respondent: Gon Sonesto Na 4 RE 1gn\oa x Residence: The address of this Petitioner is the same as my address above. a This Petitioner's address is: {Street or Route/Box) (Gv) (state) Gol Petitioner 5 (Minor Child): Name: Age: Relationship to the Respondent: Residence: Qo The address of this Petitioner is the same as my address above. Oo This Petitioner's address is: (Street or Route/Box) (Gy) (state) Gol Petitioner 6 (Minor Child): Name: Age: Relationship to the Respondent: Residence: o The address of this Petitioner is the same as my address above. oO This Petitioner's address is: (Street or Route/Box) (en) (state) ip) | SS Nalocll of perjury, the foregoing affidavit is true. Signature of Petitioner (Name, Firm name, and Bar Number IF being completed by an attorney) (do NOT sign UNTIL THE CLERK OF THE DISTRICT COURT OR A NOTARY IS PRESENT AND WITNESSES YOU SIGNING) Subscribed and swom before me on April lo 20 24 Clerk of the CourtNtotary Publis (Seal) My Commission Expires: Stateof Page 4 of 4 Petition and Affidavit to Obtain Harassment Protection Order DC 19:2 Rev. 01/20