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Nebraska Living Will Declaration Form

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The Nebraska living will form is a brief declaration of how the Principal/Declarant would like to have their medical care handled by their physician(s) in an end of life situation. This form will be created by the declarant in hopes that the family and medical team would honor their wishes according to the “Rights of the Terminally Ill Act.”

Definition –  § 20-403(3)

Laws – § 20-404

Medical Power of Attorney – Used in the event a questionable health-related decision needs to be made and the patient cannot speak on their own. The agent, selected by the patient, would be able to stand-in and be responsible for making the decision for the best viable option.

How to Write

Step 1 – Nebraska Living Will Declaration – The Declarant/Principal, must carefully read the statement provided. If the Declarant would like to make additional directions, they may do so in the lines provided on the form. They would then:

  • Enter the date of the document in dd/mm/yyyy format
  • Enter the Declarant’s Signature
  • Provide the Declarant’s complete address

Step 2 – Witnesses – This form requires the signatures of two witnesses – The witnesses must read the brief statement – If in agreement, each witness must enter:

  • Witness’ Signature
  • Witness’ Complete address

Step 3 – Notarization – If the notary public has witnessed the signatures, they too must sign the document and affix their state seal.


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