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ei <br />.11 m lit <br />C r <br />N- 241 <br />elviV1 <br />e <br />(Space Above This Line for Recording Data) <br />V AFTER RECORDING, RETURN TO: Andrew J. Huettner, Erickson j Sederstrom, 10330 Regency Parkway Drive, Suite 100, Omaha, NE 68114 <br />. U <br />REVOCABLE TRANSFER ON DEATH DEED <br />(More than One Owner) <br />Notice to Owner <br />You should carefully read all information on this form. You May Want to Consult a Lawyer <br />before Using This Form. <br />This form must be recorded with the Register of Deeds of the County in which the property is <br />located before your death and it also must be recorded with the Register of Deeds of the County <br />in which the property is located within 30 days after it was signed. If either of these <br />requirements is not met, this form will not be effective. <br />Identifying Information about Owners <br />791019 <br />Name of Owner 1 <br />George A. Poullos, <br />a married person <br />Name of Owner 2 <br />Jody J. Poullos, <br />a married person <br />Mailing Address of Owner <br />18158 Mayberry Street <br />Elkhorn, NE 68022 <br />Mailing Address of Owner <br />18158 Mayberry Street <br />Elkhorn, NE 68022 <br />George A. Poullos and Jody J. Poullos are husband and wife to each other. <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 Transfer on <br />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 survivor of <br />the Owners to the Primary Beneficiary or to the Alternate Beneficiary as provided below: <br />