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Signature of Owners Making This Transfer on Death Deed <br />Drue R. Gellatly, Transferor <br />Witness' Address <br />1508 Sherman St. <br />arah M. Gorecki, tness St. Paul, NE 68873 <br />oan M. Enevoldsen, Witness <br />506 Kearney St. <br />Wolbach, NE 68882 <br />201500552 <br />claim remaining after application of the assets of the last surviving Transferor's estate. The <br />designated beneficiary may also be personally liable, to the extent of the value of the property <br />transferred, for claims against the estate, statutory allowances to the last - surviving Transferor's <br />surviving spouse and children, and the expenses of administration to the extent needed to pay such <br />amounts by the personal representative. <br />3) The Department of Health and Human Services may require revocation of this Deed by a <br />Transferor, a Transferor's spouse, or both a Transferor and the Transferor's spouse in order to <br />qualify or remain qualified by Medicaid assistance. <br />We, Drue R. Gellatly and Minnie M. Gellatly, the Transferors, sign our names to this <br />instrument on January 7, 2015, and being first duly sworn, do hereby declare to the undersigned <br />authority that we sign and execute this Transfer on Death Deed to transfer our interest in the described <br />real property and that we sign it willingly or that one or both of us willingly direct another to sign for that <br />signer or signers, that we execute it as our free and voluntary act for the purposes therein expressed, that <br />we are eighteen years of age or older or are not at this time a minor, and that we are of sound mind and <br />under no constraint or undue influence. <br />Warning: The two witnesses must be disinterested for this Deed to be valid. Interested witness means any <br />individual who on the date that this deed is or would be entitled to receive any interest in the land if the <br />transferors died under the circumstances existing at the date of the signing of this Deed. <br />We, Sarah M. Gorecki and Joan M. Enevoldsen, the witnesses, sign our names to this instrument, <br />being first duly sworn, and do hereby declare to the undersigned authority that the Transferors sign and <br />execute this Transfer on Death Deed to transfer their interest in the described real property and they sign <br />it willingly or either or both of them willingly directs another to sign for either or both of them, and that <br />they execute it as their free and voluntary act for the purposes therein expressed, and that each of us, in <br />the presence and hearing of the Transferors, hereby signs this Deed as witness to the Transferors' signing, <br />and that to the best of his or her knowledge the Transferors are eighteen years of age or older or are not <br />at this time minors and the Transferors are of sound mind and under no constraint or undue influence. <br />Page 3 of 4 <br />