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This TOD Deed is Revocable: Before my death, I have the right to revoke this deed. Growing Crops: If this land is agricultural the growing crops shall pass to: ✓ My Primary or Alternate Beneficiary My Estate I understand that if I make no choice growing crops pass to my Estate. Legally Required Warnings in the TOD Deed: Please pay close attention to the following warnings. 20150515A 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. Warning: 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 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 Transferor's surviving spouse and children, and the expenses of administration to the extent needed to pay such amounts by the Personal Representative. Warning: The Department of Health and Human Services may require revocation of the deed by a Transferor, a Transferor's spouse, or both a Transferor and the Transferor's spouse in order to qualify or remain qualified for Medicaid assistance. Signature of Owner Making This Transfer of Death Deed: I, Dorothy M. Meyer, the Transferor, sign my name to this instrument on July 28, 2015, and being first duly sworn, do hereby declare to the undersigned authority that I sign and execute this Transfer on Death Deed to transfer my interest in the described real property and that I sign it willingly or willingly direct another to sign for me, that I execute it as my free and voluntary act for the purposes therein expressed, that I am eighteen years of age or older or am not at this time a minor, and that I am of sound mind and under no constraint or undue influence. Executed: July 28, 2015. Page 2 of 3 Dorothy M. M er, Transferor