(county where Complaint filed)

_______________________________, Case No. CI _____________(name of plaintiff on original action) (case number assigned by clerk of court)Plaintiff,

vs.

_______________________________, (name of defendant on original action) Defendant.

CERTIFICATE OF COMPLETION OF PARENTING EDUCATION COURSE

1. I am the _________________ in this action. (plaintiff or defendant)

2. On _________________, I completed a parenting education course (date)

given by one of the organizations approved by the State Court Administrator’s Office.

3. I have attached to this Certificate of Completion of Parenting Education

Course the paper I received from the Parenting Education Course provider that proves I

completed the course.

Nebraska State Court Form CERTIFICATE OF

COMPLETION OF PARENTING EDUCATION COURSE

Page 1 of 1Certificate of Completion of Parenting Education Course DC 6:5.5 Rev. 01/2020

DC 6:5.5 Rev. 01/2020 Neb. Rev. Stat. § 43-2928

Date Signature

Name Street Address/P.O. Box

City/State/ZIP Code

Phone E-mail Address