Nebraska Living Will Form

The Nebraska living will is a legal document that protects the right of the terminally ill person (Principal) to have all life sustaining medical treatment withdrawn should the Principal reach the point they are no longer able to make or communicate any choices with regard to their personal medical treatment choices. This form is brief and quite direct, therefore, if this is the document that the Principal has selected, their physicians will be directed to refer to the “Rights of the Terminally Ill Act” This document must be reviewed, witnessed and signed while the Principal is of sound mind. As long as the Principal is of sound mind, they may, in fact revoke this document at any time.

Laws – 20-401, et seq. Rights of the Terminally Ill Act

How to Write

Step 1 – Declaration – The Principal must very carefully read the paragraph at the top of the page, if in agreement:

  • If the Principal has any further instructions, they may enter the instructions into the lines provided

Step 2 – Signatures –

  • Enter the date of the Principal’s signature in dd/mm/yyyy
  • Principal must submit their signature
  • Provide the Principal’s complete address

Witnesses – The witnesses must read and agree with the witness statement:

  • Each witness must enter their respective signatures
  • Witnesses complete addresses
  • OR
  • If the Principal would prefer a notary public, they must apply they signature before the notary.
  • The notary public will then acknowledge the document by signing the document and affixing their official seal