<p>STATE OF NEBRASKA CASE NUMBER FORM NO. CC16:2.30 AFFIDAVIT OF SEX OFFENDER 01/2015 REV. REGISTRY SEARCH REQUIRED.</p><p>IN THE COUNTY COURT OF ______COUNTY, NEBRASKA</p><p>IN THE MATTER OF AFFIDAVIT OF SEX OFFENDER ______REGISTRY SEARCH Ward/Protected Person/ Incapacitated Person </p><p>I, ______, swear that I have completed the online search of the Nebraska</p><p>Sex Offender Registry for the proposed guardian or conservator as shown by the attached printouts of the </p><p> search page and results. </p><p>Date Signature</p><p>Name</p><p>Bar Number and Firm Name (attorneys only)</p><p>Street Address/P.O. Box </p><p>City/State/ZIP Code</p><p>Phone E-mail Address</p><p>State of ) ) ss. County of ) The foregoing instrument was acknowledged before me by , this Name day of , . Day Month Year</p><p>Notary Public (Signature of Person Taking Acknowledgment)</p><p>(Title or Rank) (Serial Number, if any)</p><p>CC 16:2.30 Page 1 of 2 My commission expires: </p><p>CC 16:2.30 Page 2 of 2</p>