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/Once recorded, return to: V Thomas A. Emerton P.O. Box 40 Cairo, NE 68824 Notice to Owner: Identifying Information about Owner: Ruth L Larson and Robert C. Larson wife and husband Notice to Register of Deeds: Seanne L. Emerton and Mary L. Diaz m -n c Z cs r � 2 REVOCABLE TRANSFER ON DEATH DEED You should carefully read all information on this form. You May Want To consult a Lawyer before Using This Form. This form must be recorded with the Register of Deeds of the County in which the property is located before your death and it also must be recorded with the Register of Deeds of the County in which the property is located within 30 days after it was signed. If either of these requirements is not met, this form will not be effective. Names of Owner: Mailing Address of Owner: P.O. Box 428. Cairo, NE 68824 This is a transfer on death deed and Form 521 is not required with the filing of this Transfer on Death deed under Neb. Rev. Stat. §76- 214(2)(b). Legal Description: The following real estate is transferred by this document, effective at the death of the Owner to the Primary Beneficiary or to the appropriate Alternate Beneficiary as provided below. One half interest in the Northeast Quarter of the Northwest Quarter (NE1 /4NW1 /4) of Section 31, and the Southwest Quarter (SW1 /4) of Section 30, excepting for a tract of land convey to Thomas A. Emerton and Seanne L. Emerton, which conveyance was filed as Document No. 80- 000268 in the Office of the Register of Deeds of Hall County, Nebraska, all of which is located in Township 12 North, Range 11, West of the 6 P.M., Hall County, Nebraska. Primary Beneficiary: We designate the following beneficiary of this revocable transfer on death deed if the beneficiary survives the survivor of us. Name of Primary Beneficiary: Mailing Address of Primary Beneficiary: to each an undivided one half interest as Tenants in Common. 1 (J1 CI1 CD P.O. Box 40, Cairo, NE 68824 8108 Lee Blvd, Leawood, KS 66206