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1 <br />a <br />Return to: Jonathan Hendricks, P.O. Box 5315, Grand Island, NE 68802 <br />TRANSFER ON DEATH DEED <br />RACHEL L. BROWN, a single person, GRANTOR /TRANSFEROR, hereby transfers all <br />of her interest in the following described property to the named beneficiaries LYNETTE A. <br />BROWN and GREG C. BROWN, a married couple, GRANTEES /TRANSFEREES, as joint <br />tenants and not tenants in common. Said transfer to the designated beneficiaries shall <br />only be effective at the time of the Tranferor's death. The real estate (as defined in <br />Neb. Rev. Stat. §76 -201) in Hall County, Nebraska, is legally described as follows: <br />Lot Twelve (12), Capital Heights Sixth Subdivision, in the city of Grand <br />Island, Hall County, Nebraska. <br />(Also known as 2827 Dallas Ave., Grand Island, NE 68803) <br />Pursuant to Neb. Rev. Stat. §76 -3410, the following is provided: <br />WARNING: The property transferred remains subject to inheritance taxation in <br />Nebraska to the same extent as if owned by the transferor at death. <br />Failure to timely pay inheritance taxes is subject to interest and penalties <br />as provided by law. <br />WARNING: The designated beneficiary is personally liable, to the extent of the <br />value of the property transferred, to account for medicaid reimbursement <br />to the extent necessary to discharge any such claim remaining after <br />application of the assets of the transferor's estate. The designated <br />beneficiary may also be personally liable, to the extent of the value of the <br />property transferred, for claims against the estate, statutory allowances to <br />the transferor's surviving spouse and children, and the expenses of <br />administration to the extent needed to pay such amounts by the personal <br />representative. <br />WARNING: The Department of Health and Human Services may require <br />revocation of this deed by a transferor, a transferor's spouse, or both a <br />transferor and the transferor's spouse in order to qualify or remain qualified <br />for medicaid assistance. <br />EXECUTED: July `,1 , 2016. <br />I, Rachel L. Brown, the transferor, sign my name to this instrument this IS day of <br />l 2016, and being first duly sworn, do hereby declare to the undersigned authority <br />that I sign and execute this transfer on death deed to transfer my interest in the <br />described real property and that I sign it willingly or willingly direct another to sign for <br />me, that I execute it as my free and voluntary act for the purposes therein expressed, <br />that I am eighteen years of age or older or am not at this time a minor, and that I am of <br />sound mind and under no constraint or undue,'nfl ence. <br />AV L. <br />ACHEL L. BROWN, Transferor <br />We, `6j f jPf1 J J • d . k Ai , the witnesses, sign our <br />V` declare to the <br />names to this instrument, bei duly o rn and do hereby <br />undersigned authority that the transferor firs t du nsferor signs and executes this transfer on death deed <br />