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201507784
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Last modified
5/17/2016 12:56:28 PM
Creation date
11/10/2015 4:50:11 PM
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DEEDS
Inst Number
201507784
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This TOD Deed is Revocable <br />Before my death, I have the right to revoke this deed. <br />Legally Required Warnings in the TOD Deed: <br />Please pay close attention to the following warnings: <br />Warning: <br />The property transferred remains subject to inheritance taxation in Nebraska to <br />the same extent as if owned by the transferor at death. Failure to timely pay <br />inheritance taxes is subject to interest and penalties as provided by law. <br />The designated beneficiary is personally liable, to the extent of the value of the <br />property transferred, to account for Medicaid reimbursement to the extent <br />necessary to discharge any such claim remaining after application of the assets <br />of the transferor's estate. The designated beneficiary may also be personally <br />liable, to the extent of the value of the property transferred, for claims against the <br />estate, statutory allowances to the transferor's surviving spouse and children, <br />and the expenses of administration to the extent needed to pay such amounts by <br />the personal representative. <br />Warning: <br />The Department of Health and Human Services may require revocation of this <br />deed by a transferor, a transferor's spouse, or both a transferor and the <br />transferor's spouse in order to qualify or remain qualified for Medicaid assistance. <br />Signature of owners Making This Transfer on Death Deed <br />I, David J. Wetherilt, the transferor, sign my name to this instrument on November o, <br />2015, and being first duly sworn, do hereby declare to the undersigned authority that I <br />sign and execute this transfer on death deed to transfer my interest in the described real <br />property and that I sign it willingly or that I willingly direct another to sign for that signer, <br />that I execute it as my free and voluntary act for the purposes therein expressed, that I <br />am eighteen years of age or older or am not at this time a minor, and that I am of sound <br />mind and under no constraint or undue influence. <br />We, Shelly Nielsen and Lori Ready the witnesses, sign our names to this instrument, <br />being first duly sworn, and do hereby declare to the undersigned authority that the <br />transferors sign and execute this transfer on death deed to transfer their interest in the <br />described real property and they sign it willingly or either or both of them willingly directs <br />another to sign for either or both of them, and that they execute it as their free and <br />voluntary act for the purposes therein expressed, and that each of us, in the presence <br />and hearing of the transferors, hereby signs this deed as witness to the transferors' <br />signing, and that to the best of his or her knowledge the transferors are eighteen years <br />of age or older or are not at this time minors and the transferors are of sound mind and <br />under no constraint or undue influence. <br />Shelly Nielsen <br />' <br />Lori Re <br />Page 2 <br />2015 U7784 <br />David — J. I�Vet erilt, Trans er <br />308 N. Locust St. #308, Grand Island, NE <br />Witness address <br />308 N. Locust St. #308, Grand Island, NE <br />Witness address <br />Wetherilt TOD Deed <br />323 East South St., Grand Island, NE <br />
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