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The Southerly Fourteen and Twenty Four Hundredths (14.24) feet of Lot Seven (7), and the Northerly Forty One and Sixty Four Hundredths (41.64) Feet of Lot Nine, all in Block Five (5) in University Place, an Addition to Grand Island, Hall County, Nebraska 201501191 Primary Beneficiary We designate the following beneficiaries of this revocable transfer on death deed if the beneficiary survives the survivor of us. Name of Primary Beneficiary Mailing Address of Primary Beneficiary Cheryl Ann Larsen 12345 Wasatch Road, Longmont, CO 80504 Weston Larsen 12345 Wasatch Road, Longmont, CO 80504 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 hours. This TOD Deed is Revocable Before our death, we (or the survivor of us) have the right to revoke this deed. Legally Required Warnings in the TOD Deed: Please pay close attention to the following warnings: 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. 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 last surviving 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 last- surviving transferor's surviving spouse and children, and the 2