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0 W c 1 Return to: Denise Myers, Attorney 611 N. Diers Ave., Ste 1 Grand Island, NE 68803 Notice to Owner: m -n C z a r m REVOCABLE TRANSFER ON DEATH DEED Identifying Information about Owner: Names of Owner. Mailing Address of Owner: Kerry J. Sheeks 4022 Buckingham Drive Grand Island, NE 68803 Kristy J. Potthoff 104131'' Ave. Kearney, NE 68847 Roxanne J. Sheeks 2321 W. Oklahoma Ave. Grand Island, NE 68803 Suzanne J. Sheeks P.O. Box 407 Cairo, NE 68824 Transfer on Death: Survivorship Required: This TOD Deed is Revocable: Before my death, 1 have the right to revoke this deed. m rt j W J V.. You should carefully read all information on this form. You may want to consult a Lawyer before using this Form. If you are married and both spouses do not sign this deed, the deed may be void. 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. James H. Sheeks, Jr. 7107 N. NE Hwy 11 (A single person) Cairo, NE 68824 Notice to Register of Deeds: 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. The South Half of the Southwest Quarter (S1/2SW1/4) of Section Seven (7), Township Twelve (12) North, Range Eleven (11), West of the 6 P.M., Hall County, Nebraska, EXCEPTING therefrom Lot One (1), Sheeks Subdivision, Hall County, Nebraska. Primary Beneficiary: 1 designate the following beneficiaries of this revocable transfer on death deed if the beneficiaries survive me. Name of Primary Beneficiary: Mailing Address of Primary Beneficiary: At my death, I transfer my interest in the described property to the beneficiaries as designated above. The transfer occurs at my death. Under Nebraska Law, the interest of a designated beneficiary is contingent on the designated beneficiary surviving the transferor by one hundred twenty (120) hours.