TEMPORARY DELEGATION OF PARENTAL POWERS
I, [PARENT / GUARDIAN NAME] of [PARENT / GUARDIAN CITY], Nebraska do make and appoint [TEMPORARY GUARDIAN NAME], of [TEMPORARY GUARDIAN ADDRESS / CITY / STATE], act for me and in my name to exercise all my powers regarding the care, custody and property of [MINOR CHILD NAME], born [MM/DD/YYYY], except my power to consent to marriage and adoption of the child.I hereby give [TEMPORARY GUARDIAN NAME] full authority and power to do everything necessary to be done, as fully as I could or might do if personally present, for a period not exceeding six months beyond this date.I confirm and ratify all lawful acts done, or caused to be done by [TEMPORARY GUARDIAN NAME] acting under this Delegation of Powers regarding the care, custody and property of my child. This Delegation of Parental Powers may be revoked by me at any time before the expiration of this six-month period by written notice to [TEMPORARY GUARDIAN NAME] at the address above.Signed: _________________________________ Date [MM/DD/YYYY]

[PARENT / GUARDIAN NAME]
[PARENT / GUARDIAN STREET ADDRESS/P.O. BOX]
[PARENT / GUARDIAN BAR NUMBER / FIRM NAME (ATTORNEYS ONLY]
[PARENT / GUARDIAN CITY/STATE/ZIP CODE]
[PARENT / GUARDIAN PHONE]
[PARENT / GUARDIAN EMAIL ADDRESS]

State of __________)
) ss.
County of ________)

The foregoing instrument was acknowledged before me by __________________, this ____ day of ________, _______.

_________________________________
Notary Public

_______________________ _______________________
(title or rank)                                       (serial number, if any)

My commission expires: _______________