State of .......... )
County of .......... )
I, .............., do hereby designate .............. with the right to control the disposition of my remains upon my death. I (...... have) (...... have not) attached specific directions concerning the disposition of my remains which the designee shall substantially comply with, so long as such directions are lawful and there are sufficient resources in my estate to carry out the directions. This affidavit does not constitute a durable power of attorney for health care.
......................... (signature of person executing affidavit)
Subscribed and sworn to before me this ...... day of the month of ............ of the year .......
......................... (signature of notary public);
Neb. Rev. Stat. §§ 30-2223