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64 0 <br />3 .7 ` 5 in o <br />J � " -� `� Ca <br />RI E <br />0 <br />n = . <br />Identifying Information about Owner <br />Name of Owner <br />Rosella E. Maughan <br />REVOCABLE TRANSFER ON DEATH DEED <br />(Single Owner) <br />Cr) <br />Notice to Owner <br />You should carefully read all information on this form. You May Want to Consult a Lawyer <br />before Using This Form. <br />This form must be recorded with the Register of Deeds of the County in which the property is <br />located before your death and it also must be recorded with the Register of Deeds of the County <br />in which the property is located within 30 days after it was signed. If either of these requirements <br />is not met, this form will not be effective. <br />Mailing Address of Owner <br />1515 Stagecoach Road <br />Grand Island, NE 68801 <br />Notice to Register of Deeds <br />This is a transfer on death deed and Form 521 is not required with the filing of this Transfer on <br />Death deed under Neb.Rev. Stat. §76-214(2)(b). <br />Legal Description <br />The following real estate is transferred by this document, effective at the death of the Owner to <br />the Primary Beneficiary or to the Alternate Beneficiary as provided below. <br />Lot Two (2), Coach Place Third Subdivision in the City of Grand Island, <br />Hall County, Nebraska <br />9,g d0 <br />r <br />z <br />0 <br />