STATE OF NEBRASKA

Nebraska State Court Form

REQUIRED

CC 4:5 Rev. 07/2024

Neb. Rev. Stat. § 25-2804(3)

Plaintiff,

vs.

Defendant.

Case No.____________________

SMALL CLAIMS

CERTIFIED MAIL

RETURN

I acknowledge that a copy of the small claims complaint was mailed to each

defendant by certified mail, return receipt requested.

Defendant:

Case Number:

Trial Date:

1. Certified mail was mailed on

2. Return receipt was signed on

3. Certified mail was returned unsigned on

4. Postage $

CC 4:5 Rev. 07/2024 Page 1 of 2 Small Claims Certified Mail Return

Date:

Signature:

Printed Name:

Street Address/P.O. Box:

City/State/ZIP Code:

Telephone Number:

Email address:

IN THE COUNTY COURT OF

______________ COUNTY, NEBRASKA

Choose the county

These written instructions are prepared by the State Court Administrator in accordance with the

provisions of Neb. Rev. Stat. § 25-2804(3) and are available at http://supremecourt.ne.gov/forms .

NOTICE TO PLAINTIFF:

Notice shall be served on each defendant not less than five days before the time set for

hearing. Proper service on the defendant is essential, without it your lawsuit will be

dismissed. Since you have chosen to have your small claims claim served upon the

defendant by certified mail, you should follow these instructions.

1. Place a copy of your claim in an envelope of sufficient size, addressed to the defendant and

take it to a United States Post Office.

2. Inform the postal clerk that you want the letter mailed by Certified Mail - Restricted Delivery -

Return Receipt Requested. (Although Restricted Delivery is not required by statute, most

judges will require proof of service upon the actual defendant, as opposed to just any person

at the defendant’s address, prior to entering a default judgment against the defendant if he or

she does not appear at the scheduled hearing.)

3. You will be charged:

$ 0.73

$ 4.85

$ 7.90

$ 4.10

a. Postage

b. Certified Mail

c. Restricted Delivery

d. Return Receipt Requested

Total:

$17.58

4. They will give you Form 3800, Receipt for Certified Mail. Enter the address of the defendant on

the top portion of the receipt, then detach the label with the certified number and place it on the

letter above the address and to the right of the return address. *An electronic Return Receipt is

available for a reduced charge of $2.62. Talk to your post master for more information.

5. Write “Restricted Delivery” and “Return Receipt Requested” on the face of the envelope.

6. Give it to the postal clerk who will check it over, collect your fees and return a copy of Form

3800 to you which will be your proof of certified mailing.

7. Once the certified mail is delivered to the defendant, the postal clerk will send you a returned

receipt showing the defendant’s signature. This is your proof of personal service on the

defendant.

8. If the mail is not delivered, the postal clerk will leave a notice of certified mail at the

defendant’s address. If, after five days, the mail is not called for, a final notice is issued. The

mail will be returned to you 15 days after the first unsuccessful delivery attempt.

9. Proper service on the defendant is essential. If you are unsuccessful, you will have to begin

the service process all over again.

RETURN INSTRUCTIONS:

Complete the preceding form, then attach the green certified mail return receipt

postcard to the top of the form and return it to the Clerk of the Court at least five days

prior to the trial date.

CC 4:5 Rev. 07/2024 Page 2 of 2 Small Claims Certified Mail Return