Nebraska Limited (Special) Power of Attorney Form

The Nebraska limited (special) power of attorney form is a document which details the transference of authority from one individual (the “Principal”) to another, to be effective in the event that the Principal is away or otherwise unavailable to conduct certain tasks. Contrary to a standard POA form, the limited (special) form contains instructions that shall be implemented under specific circumstances only. The individual appointed to perform these tasks is known as the “Agent”; the Agent must operate in the best interests of the Principal and do so in good faith. In accordance with State law, the signature of the Principal is only deemed genuine if it is recognized by the Principal in the presence of a Notary Public (NE Code § 30-4005 (2013)).

How to Write

Step 1 – Download the document to provide so that The Principal may begin by reviewing the following titles:

  • Notice
  • Incapacitation
  • Revocation
  • Witness and Notary

Step 2 – Principal’s Information – Provide the following information:

  • Principal’s Name
  • The Principal’s Street Address
  • City
  • State
  • AND
  • Enter the full name of the selected Agent
  • The Street Address
  • City
  • State
  • Enter the state in which the document will be used
  • AND
  • Enter Successor Agent (in the event the initial agent is unable to serve – optional)
  • Street Address
  • City
  • State
  • Enter the state where the document will be executed by any Agent

Step 3 – Additional Titles for review by the Principal

  • Terms and Conditions
  • Third Parties
  • Compensation
  • Disclosure

Step 4 – Signatures – Must be signed before a notary:

  • Printed Name of  the Principal
  • Date of the Principal’s  signature in dd/mm
  • Reviewthe remaining portion of the paragraph
  • Enter the Principal’s Signature
  • AND
  • Enter the Agent’s Printed Name
  • Signature of the Agent
  • Date of Signature in mm/dd/yyyy format
  • AND
  • Successor Agent’s Printed or Typed Name
  • Signature of the Successor Agent
  • Date the Signature in mm/dd/yyyy format

Step 5 – Notary Acknowledgement –

The Notary Public shall witness all of the signatures submitted by all signatories, afterwhich, the Notary Public will complete the form by entering all required Notary information acknowledginf along with the submission of the official seal

Step 6 – Acknowledgement and Acceptance of Appointment by the Agents – The next two paragraphs will ask that the Agents Accept their appointment. Once the Agent’s review this information, enter the following:

  • Agent’s printed name
  • Signature of Agent
  • Date the signature in mm/dd/yyyy format
  • AND
  • The Successor Agent’s printed name
  • Successor Agent’s Signature
  • Date the Agent’s signature in mm/dd/yyyy format
  • AND

Witness Attestation – Both witnesses must review the information contained in the paragraph provided, if in agreement, provide the following:

  • Print the names of the witnesses, respectvely
  • Signature of each witness