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Identifying Information about Owner Name of Owner David J. Wetherilt An Unmarried Person Return to: Jerom E. Janulewicz, 308 North Locust Street, Suite 306, Grand Island, NE 68801 REVOCABLE TRANSFER ON DEATH DEED Notice to Owners You should each carefully read all information on this form. You may want to consult a Lawyer before using this form. This form must be recorded with the Register of Deeds of the County in which the property is located before your death and it also must be recorded with the Register of Deed of the County in which the property is located within 30 days after it was signed. If either of these requirements is not met, this form will not be effective. Mailing Address of Owner 211 W. 3 Street Grand Island, NE 68801 Notice to Register of Deeds This is a transfer on death deed and Form 521 is not required with the filing of this Transfer on Death deed under Neb.Rev.Stat. § 76- 214(2)(b). Legal Description The following real estate is transferred by this document, effective at the death of the Owner to the Primary Beneficiary as provided below. Lot Two (2), Baker's Second Addition to the City of Grand Island, Hall County, Nebraska. Primary Beneficiary I designate the following primary beneficiary of this revocable transfer on death deed if the primary beneficiary survives me: my son, Brian D. Wetherilt, currently of Little Elm, Texas. Page 1 Transfer on Death At my death, I transfer my interest in the described property to the beneficiary as designated above. The transfer occurs at the death of the Transferor. Survivorship Required Under Nebraska law, the interest of a designated beneficiary is contingent on the designated beneficiary surviving the transferor by one hundred twenty hours. • r C7 Wetherilt TOD Deed 2404 West First Street, Grand Island, NE