eForms Logo

Nebraska Living Will Declaration Form

Create a high-quality document now!

Nebraska Living Will Declaration Form

Updated August 03, 2023

A Nebraska living will form is a brief declaration of how the Principal/Declarant would like to have their medical care handled by their physician 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.”


  • Signing Requirements – Two (2) witnesses or a notary public (20-404(1)).
  • Statutes – § 20-404

How to Write

Download: PDF, MS Word, OpenDocument

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.