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201403276 Primary Beneficiary I designate the following beneficiary of this revocable transfer on death deed if the beneficiary survives me. Name of Primary Beneficiary Kathleen Ann Maughan Keenan If living, and if not, to her issue, by right of representation. If living, and if not, to her issue, by right of representation. Legally Required Warnings in the TOD Deed: Please pay close attention to the following warnings. Mailing Address of Primary Beneficiary 2901 W Leota St. North Platte, NE 69101 -6383 Colleen Ellen Maughan Connely #4 21' Ave P1 Kearney, NE 68845 -4245 Transfer on Death At my death, I transfer my interest in the described property to the beneficiaries as designated above. The transfer occurs at the death of the Transferor. Survivorship Required Under Nebraska law, the interest of a designated beneficiary is contingent on the designated beneficiary surviving the transferor by one hundred twenty hours. 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 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 transferor's surviving spouse and children, and the expense of administration to the extent needed 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.