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Primary Beneficiary: 201308433 We designate the following beneficiaries of this revocable transfer on death deed if the beneficiaries survive the survivor of us. Names of Primary Beneficiaries: Mailing Addresses of Primary Beneficiaries: Elizabeth A. Tipping 7777 Baron Court, El Cerrito, CA 94530 John R. Heckman 1042 Eldorado Drive, Superior, CO 80027 Transfer on Death: At the death of the survivor of us, we transfer our interest in the described property to the beneficiaries as designated above. The transfer occurs at the death of the survivor of the Transferors. Survivorship Required: Under Nebraska law, the interest of a designated beneficiary is contingent on the designated beneficiary surviving the transferor by one hundred twenty (120) hours. This TOD Deed is Revocable: Before my death, I have the right to revoke this deed. Growing Crops: If this land is agricultural land the growing crops shall pass to: X My primary or alternate beneficiary My estate I understand that if I make no choice growing crops pass to my estate. Legally Required Warning in the TOD Deed: Please pay close attention to the following warnings: Warning: The property transferred remains subject to inheritance taxation in Nebraska to the same extent as if owned by the transferor at death. Failure to timely pay inheritance taxes is subject to interest and penalties as provided by law. Warning: The designated beneficiary is personally liable, to the extent of the value of the property transferred, to account for Medicaid reimbursement to the extent necessary to discharge any such claim remaining after application of the assets of the last surviving transferor's estate. The designated beneficiary may also be personally liable, to the extent of the value of the property transferred, for claims against the estate, statutory allowances to the last surviving transferor's surviving spouse and children, and the expenses of administration to the extent to pay such amounts by the personal representative. Warning: The Department of Health and Human Services may require revocation of this deed by a transferor, a transferor's spouse, or both a transferor and the transferor's spouse in order to qualify or remain qualified for Medicaid assistance.