Nebraska Durable Power of Attorney
This Durable Power of Attorney is created pursuant to the Nebraska Uniform Power of Attorney Act. It grants the person(s) you designate as your Attorney-in-Fact, or Agent, broad powers to handle your affairs. This document remains effective even if you become disabled or incapacitated.
Notice: The powers granted by this document are broad and sweeping. They may include the power to dispose of, sell, convey, and encumber your real and personal property. If you have any questions about these powers, you should seek legal advice before signing this document.
Principal Information
Full Name: _______________________________
Address: _________________________________
City, State, Zip: __________________________
Phone Number: ____________________________
Attorney-in-Fact/Agent Information
Full Name: _______________________________
Address: _________________________________
City, State, Zip: __________________________
Phone Number: ____________________________
Powers Granted
Select the powers you are granting to your Attorney-in-Fact by initialing each applicable line:
- _____ Real property transactions
- _____ Tangible personal property transactions
- _____ Stock and bond transactions
- _____ Commodity and option transactions
- _____ Banking and other financial institution transactions
- _____ Business operating transactions
- _____ Insurance and annuity transactions
- _____ Estate, trust, and other beneficiary transactions
- _____ Claims and litigation
- _____ Personal and family maintenance
- _____ Benefits from social security, Medicare, Medicaid, or other governmental programs, or military service
- _____ Retirement plan transactions
- _____ Tax matters
Special Instructions
If you have any special instructions limiting or extending the powers you are granting to your Attorney-in-Fact, write them here:
__________________________________________________________________
__________________________________________________________________
Effective Date and Duration
This Durable Power of Attorney is effective immediately upon signing and remains in effect indefinitely unless revoked by me in writing or until my death.
Signature
Date: ___________________________
Principal's Signature: ___________________________
Principal's Printed Name: _________________________
Statement of Witness
I declare that the Principal appears to be of sound mind and free from duress at the time of signing this Durable Power of Attorney, and that they affirmatively acknowledge that this is the Durable Power of Attorney and that they grant the powers to the Attorney-in-Fact willingly.
Date: ___________________________
Witness's Signature: ___________________________
Witness's Printed Name: _________________________
Notarization
This document was acknowledged before me on Date: _____________ by _______________________ (Principal’s name).
Notary Public's Signature: _________________________
Notary Public's Printed Name: _____________________
Commission expires: ___________________