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TRANSFER ON DEATH <br />At my death, I transfer my interest in the described property to the beneficiaries <br />as designated above. Before my death, I have the right to revoke this deed. <br />201404698 <br />SURVIVORSHIP REQUIRED <br />The interest of a beneficiary is contingent upon the beneficiary surviving the <br />transferor by 120 hours. <br />I, Charlotte J. Rerucha, single, the Transferor, sign my name to this instrument <br />this day of 2014, and being first duly sworn, do hereby declare to the <br />undersigned aut ity t t I sign and execute this transfer on death deed to transfer my <br />interest in the described real property and that I sign it willingly or willingly direct another <br />to sign for me, that I execute it as my free and voluntary act for the purposes therein <br />expressed, that I am eighteen years of age or older and am not at this time a minor, and <br />that I am of sound mind and under no constraint or undue influence. <br />C arlotte J. Rerucha <br />We, Sheila Nielsen and Lori J. Ready, the witnesses, sign our names to this <br />instrument, being first duly sworn, and do hereby declare to the undersigned authority <br />that the transferor signed and executed this Transfer on Death Deed to transfer her <br />interest in the described real property and they she signed it willingly or willingly directs <br />another to sign for her and that she executes it as her free and voluntary act for the <br />purposes therein expressed, and that each of us, in the presence and hearing of the <br />transferor, hereby signs this deed as witness to the transferor's signing, and that to the <br />best of her knowledge the transferor is eighteen years of age or older or are not at this <br />time a minor and the Transferor is of sound mind and under no constraint or undue <br />influence. <br />Sheila Nielsen, Witness <br />R , Wi ess <br />Lori J. y <br />STATE OF NEBRASKA ) <br />) ss: <br />COUNTY OF HALL ) <br />The foregoing instrument was acknowledged before me on the / day of <br />, 2014, by Charlotte J. Rerucha, single, and Sheila Nielsen and Lori J. <br />Ready, *itnesses. <br />GENERAL NOTARY - State ot Nebraska <br />DUANE A. BURNS <br />My Comm. Exp. March 28, 2016 <br />Not ry Public <br />2 <br />