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Identifying Information. about Owner <br />Name of Owner <br />David J. Wetherilt <br />A Single Person <br />rrt <br />-17 X44 <br />rt n v. <br />n <br />X <br />r \) <br />C_ J <br />Return to: Jerom E. Janulewicz, 308 North Locust Street, Suite 306, Grand Island, NE 68801 <br />REVOCABLE TRANSFER ON DEATH DEED <br />Notice to Owners <br />You should each carefully read all information on this form. You may want to consult a <br />Lawyer before using this form. <br />This form must be recorded with the Register of Deeds of the County in which the <br />property is located before your death and it also must be recorded with the Register of <br />Deed of the County in which the property is located within 30 days after it was signed. If <br />either of these requirements is not met, this form will not be effective. <br />Mailing Address of Owner <br />211 W. 3 Street <br />Grand Island, NE 68801 <br />Notice to Register of Deeds <br />This is a transfer on death deed and Form 521 is not required with the filing of this <br />Transfer on Death deed under Neb.Rev.Stat. § 76- 214(2)(b). <br />Legal Description <br />The following real estate is transferred by this document, effective at the death of the <br />Owner to the Primary Beneficiary as provided below. <br />