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Name of Primary Beneficiaries Mailing Address of Primary Beneficiaries William D. Gellatly Sean D. Gellatly Travis R. Gellatly Farra F. Gellatly 25409 Thoreau W. Stevenson Ranch, CA 91381 3080 W. Cedarview Rd. Doniphan, NE 68832 2209 N. 176 Ave. Omaha, NE 68116 208 Sunny Dr. Doniphan, NE 68832 201500552 Alternate Beneficiary If our Primary Beneficiaries do not survive us, we designate the following Alternate Beneficiary if that Alternate Beneficiary survives the survivor of us. Name of Alternate Beneficiary Mailing Address of Alternate Beneficiary Transfer on Death At the death of the survivor of us, we transfer our interest in the described property to the beneficiaries as designated above. The transfer occurs at the death of the survivor of the Transferors. Survivorship Required Under Nebraska law, the interest of a designated beneficiary is contingent on the designated beneficiary surviving the survivor of the Transferors by one hundred twenty (120) hours. This Transfer on Death Deed is Revocable Before our death, we (or the survivor of us) have the right to revoke this Deed. Growing Crops If this land is agricultural land the growing crops shall pass to: ❑ The Primary or Alternate beneficiary ❑ The estate of the survivor of us We understand that if we make no choice growing crops pass to the estate of the survivor of us. Legally Required Warnings in the Transfer on Death Deed: Please pay close attention to the following warnings: 1) 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. 2) 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 3e4 Page 2 of 4