Nebraska Code § 32-620.01

President; nonpartisan candidates; nomination petition; form.
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In addition to the requirements of subsection (3) of section 32-620, the form of a petition for nonpartisan candidates for President of the United States shall be substantially as follows:
Petition for Office of President of the United States
Name of Candidate: ............
Residence Address: ............
City, State, and Zip Code: ............
To the Honorable ............, Secretary of State for the State of Nebraska:
We, the undersigned residents of the State of Nebraska and the county of ............, respectfully demand that the above-named candidate be placed on the ballot at the general election to be held on the .... day of ......... 20...., and each for himself or herself says:
I have personally signed this petition on the date opposite my name;
I am a registered voter of the State of Nebraska and the county of ............ and am qualified to sign this petition or I will be so registered and qualified on or before the date on which this petition is filed with the Secretary of State; and
My printed name, date of birth, street and number or voting precinct, and city, village, or post office address are correctly written after my signature.
(Here follow numbered lines for signature, printed name, date of birth, date, street and number or voting precinct, and city, village, or post office address.)

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