Nebraska Advance Directive

Information you will need

• Agent Name
• Agent Address
• Successor Agent Name
• Successor Agent Address
• Successor Agent Phone
• Authority of Agent
• Instructions or Limitations
• Instructions for Agent
• Life Sustaining Treatment
• Nutrition and Hydration Instructions
• Life Sustaining Treatment Instructions
• Nutrition and Hydration
• Understanding of Document
• Second Witness Name
• Principal Signing Date
• Notary Only: Date
• Notary Only: Principal Name
• Principal Signing Day
• Principal Signing Month
• Principal Signing Year
• Principal Name
• Principal SSN
• Agent Phone
• Principal Address

…and 5 more fields in the PDF.

Completed by the principal.

The form includes 4 signature lines, a notary acknowledgment, a witness section.

The document text refers to the laws of Nebraska.