Final Wishes Form
We have been asked by several departments to come up with a template on “Final Wishes” that their department could use…
Purpose of form: The information in this form guides your Fire Chief regarding your wishes to be carried out upon your death.
Privacy Statement: This information may be protected by the current laws, rules, regulations, and policies regarding privacy and confidentiality as mandated by your Fire Department and Rescue Squad, Inc., in your City of and the State of Nebraska or any other agency or branch of government.
Instructions for completing this Final Request Form: Before completing this form, read each statement carefully on the Memorandum that accompanies this form. After you have read the Memorandum, complete each item on this form. If the item does not apply or you prefer not to provide the information, specify by writing ‘N/A’ to the item. Please print or type.
PSOB Designee Form
The PSOB Designee form is for use in declaring a beneficiary for any PSOB benefits that your survivors may be eligible for in the event of your death. The circumstances in which the beneficiaries identified here might be eligible for the PSOB benefit identified in Step 4 and would not apply if there is an eligible surviving spouse and/or children. Should you wish to complete this form, it must be retained with official department records.
Nebraska Line of Duty Compensation Act LB196
Nebraska Line of Duty Compensation Act LB 196 (pdf)
