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Nebraska Hhs 73 Form

The Nebraska HHS 73 form is a crucial document used to record the dissolution of marriage or annulment in the state of Nebraska. This form gathers essential information about both parties involved, including their names, birth dates, and current residences, as well as details about children and any settlements made. Completing this form accurately is vital for processing legal matters related to marriage dissolution, so it is important to fill it out correctly and promptly.

To begin the process, please click the button below to fill out the Nebraska HHS 73 form.

Open This Nebraska Hhs 73

Structure

The Nebraska HHS 73 form serves a critical function in the dissolution of marriage process, specifically within the context of county or tribal courts. This worksheet is essential for documenting vital information related to the marriage, including the names and birth details of both spouses, their current residences, and the specifics surrounding their marriage. It requires the entry of the court record number, which links the form to the appropriate legal case. Additionally, the form gathers information about children under 18 who may be affected by the dissolution, ensuring that custody arrangements are clearly outlined. The parties involved must also provide details regarding any settlements made, such as alimony or child support, which helps to clarify financial responsibilities post-divorce. Furthermore, the form collects demographic information, including the racial and ethnic identities of both spouses, which can be relevant for various administrative purposes. This comprehensive approach ensures that all pertinent details are recorded, facilitating the legal process while also providing necessary data for state health and human services.

Document Preview Example

1.฀฀County/Tribal฀Court฀฀฀฀฀฀฀฀State฀of฀Nebraska

Department฀of฀Health฀and฀Human฀Services฀Finance฀and฀Support

Vital฀Records

฀฀2.฀฀Court฀Record฀Number฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀cate฀of฀Dissolution฀of฀Marriage฀or฀Annulment

Certiﬁ

WORKSHEET฀ONLY

฀฀3.฀฀Husband’s฀Name฀(First,฀Middle,฀Last,฀Sufﬁ฀x)

฀฀4a.฀฀Current฀Residence฀-฀Country฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀ ฀ ฀ ฀ ฀

4b.฀฀State฀ ฀ ฀ ฀

4c.฀฀County

฀฀4d.฀City,฀Town฀or฀Location฀฀ ฀ ฀ ฀ ฀

4e.฀฀Residence฀-฀Street฀and฀Number฀ ฀ ฀ ฀

4f.฀฀Zip฀Code

฀฀5.฀฀Place฀of฀Birth฀(City฀and฀State฀or฀Foreign฀Country)฀฀ ฀ ฀ ฀ ฀ ฀

6.฀฀Date฀of฀Birth฀(Mo.,฀Day,฀Yr.)

฀฀7a.฀฀Wife’s฀Name฀(First,฀Middle,฀Last,฀Sufﬁ฀x)฀฀ ฀

฀

฀฀8a.฀฀Current฀Residence฀-฀Country฀฀

฀

8b.฀฀State฀฀ ฀

฀

8c.฀฀County

฀฀฀8d.฀City,฀Town฀or฀Location฀฀ ฀ ฀ ฀ ฀

฀8e.฀฀Residence฀-฀Street฀and฀Number฀ ฀ ฀ ฀

8f.฀฀Zip฀Code

฀฀9.฀฀Place฀of฀Birth฀(City฀and฀State฀or฀Foreign฀Country)฀฀ ฀ ฀ ฀ ฀ ฀

10.฀฀Date฀of฀Birth฀(Mo.,฀Day,฀Yr.)

	฀11a.฀฀Place฀of฀Marriage฀-฀State฀				฀
฀	฀	฀	฀	฀	฀

11b

.฀฀County฀฀฀

฀

฀฀฀฀

฀฀฀฀฀฀฀฀฀฀฀฀

11c.฀฀City฀

฀

11d.฀฀Date฀of฀Marriage

฀(Mo.,฀Day,฀Yr.)

฀฀12a.฀฀Number฀of฀Children฀under฀18฀in฀this฀Household฀฀

฀

฀฀12b.฀฀Number฀of฀Children฀Under฀18฀Whose฀Physical฀Custody฀was฀Awarded฀to:

฀

฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀฀

Husband฀฀฀฀฀฀฀฀฀

Wife฀฀฀฀฀฀฀฀฀฀฀฀฀

Joint฀Husband/Wife฀

฀฀฀฀฀฀฀฀฀฀฀Number

฀฀

฀฀฀฀฀฀฀฀฀฀฀

Other

_______________฀฀฀฀฀฀

฀

฀฀

฀

฀No฀Children฀Awarded฀Custody฀

฀13.฀฀Plaintiff฀฀฀

฀

฀฀14.฀฀List฀Former฀Name฀of฀Wife,฀if฀restored

฀฀Husband฀฀฀฀ ฀฀Wife฀

฀15a.฀฀Attorney฀for฀Plaintiff฀-฀Name฀

฀

฀฀

15b.฀฀Address฀(Street,฀City฀or฀Town,฀State฀and฀Zip฀Code)

฀฀16a.฀฀I฀certify฀that฀the฀marriage฀of฀the฀above฀name฀persons฀was฀dissolved฀on฀฀ ฀										16b.฀฀Type฀of฀Decree
฀฀฀฀฀฀฀฀฀฀฀(Mo.,฀Day,฀Yr.)฀฀	฀	฀	฀	฀	฀	฀	฀	฀	฀	฀฀฀฀฀฀฀฀฀฀______Dissolution฀฀฀฀฀฀______Annulment

฀17.฀฀Clerk฀of฀the฀District฀Court฀or฀Tribal฀Court฀Making฀Return฀to฀the฀Department฀of฀Health฀and฀Human฀Services฀Finance฀and฀Support

฀Information฀For฀Administrative฀Use฀Only.฀Information฀below฀will฀not฀appear฀on฀certiﬁ฀ed฀copies฀of฀the฀record

18.฀฀Settlement(s)฀Made

฀฀฀฀฀฀฀฀฀฀Alimony ฀฀Yes฀ ฀฀No฀฀฀฀฀฀Child฀Support฀ ฀฀Yes ฀฀No฀฀฀฀฀฀฀Property฀Settlement฀ ฀฀Yes฀ ฀฀No฀฀฀฀฀฀฀Medical฀Reimbursement฀ ฀฀Yes฀ ฀฀No

19.฀฀Social฀Security฀Numbers

฀Husband: ฀฀Wife:

20a.	Is Husband of Hispanic or Latino Origin?	฀฀Yes฀฀ ฀฀No	20b. Is Wife of Hispanic or Latina Origin?		฀฀Yes฀฀ ฀฀No
	21a. Husband	Race		21b. Wife
	Check the race(s) each person considers him/herself to be
		White/Caucasian		
		Black or African American		
		American Indian or Alaska Native		
		Asian		
		Native Hawaiian or Other Paciﬁ c Islander		

HHS-73฀(55073)฀6/06

⇓ PDF File

File Information

Fact Name	Details
Governing Law	The Nebraska HHS 73 form is governed by Nebraska Revised Statute § 42-364, which outlines the dissolution of marriage and annulment procedures.
Purpose	This form is used to collect essential information for the dissolution of marriage or annulment in Nebraska.
Form Type	The HHS 73 form is categorized as a worksheet only, meaning it is not a final legal document but serves as a preparatory tool.
Required Information	It requires details about both spouses, including names, birth dates, and current residences.
Children Information	The form asks for the number of children under 18 living in the household and custody arrangements.
Legal Representation	Attorneys representing either party must provide their name and address on the form.
Certification	Both parties must certify the dissolution date and type of decree, either dissolution or annulment.
Social Security Numbers	The form requests the social security numbers of both spouses for identification purposes.
Demographic Information	It includes questions regarding the ethnic background and race of both spouses.
Administrative Use	Some sections of the form are designated for administrative purposes and will not appear on certified copies.

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