Nebraska Hhs 73 Form PDF Details

Do you need to file a statement of financial support for your dependent in the state of Nebraska? It can seem overwhelming to gather all the required documents, but don’t worry! Here at HelpfulESupports, we make sure that it doesn't have to be a stressful process. Having an understanding of what documentation is needed and where to get it ensures that your paperwork goes through without any issues. The key document you'll need is called a Nebraska HHS 73 Form, or Statement of Financial Support for Dependents. In this blog post, we will walk you through everything you need to know about filling out this form accurately and efficiently so you can focus on more important tasks. Let's dive in!

QuestionAnswer
Form NameNebraska Hhs 73 Form
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other names11d, nebraska hhs 73 55073, rk, 20b

Form 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

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20b completion process explained (portion 1)

2. Soon after filling out the previous part, go on to the next part and fill in the necessary details in these blanks - dCityTownorLocation, h h h h h h h h h h h h h h h h h, s s s s s s s s s s s s s s s s s, eResidenceStreetandNumber, fZipCode fZipCode, W o r k W o r k W o r k W o r k W, aPlaceofMarriageState, bCounty bCounty bCounty bCounty, DateofBirthMoDayYr, cCity cCity cCity cCity, dDateofMarriage dDateofMarriage, HusbandWifeJointHusbandWife, Other Other, NoChildrenAwardedCustody, and aAttorneyforPlaintiffName.

dCityTownorLocation, Other Other, and eResidenceStreetandNumber in 20b

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Writing segment 3 in 20b

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