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LEGALLY REQUIRED WARNINGS IN THE TRANSFER ON DEATH DEED <br />Please pay close attention to the following warnings: <br />Warning: The property transferred remains subject to inheritance taxation in Nebraska to the <br />same extent as if owned by the transferor at death. Failure to timely pay inheritance taxes is <br />subject to interest and penalties as provided by law. <br />Warning: 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 necessary to discharge <br />any such claim remaining after 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 property transferred, for <br />claims against the 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 the personal <br />representative. <br />Warning: The Department of Health and Human Services may require revocation of this deed by <br />a transferor, a transferor's spouse or both a transferor and the transferor's spouse in order to <br />qualify or remain qualified for Medicaid assistance. <br />We, Todd A. Babka and Lisa A. Babka, the transferors, sign our names to this instrument this 29th <br />day of June, 2017, , - d being first duly sworn, do hereby declare to the undersigned authority that we sign <br />and execute er on death deed to transfer our interest in the described real property and that we <br />sign it Willi . e execute it as our free and voluntary act for the purposes therein expressed, that <br />we a - f age or older or are not at this time a minor, and that we are of sound mind and <br />ndue influence. <br />TO P I A B = Transferor <br />We, <br />Printed Name: Ein ce 6ifilvo—) <br />STATE OF NEBRASKA ) <br />) ss. <br />COUNTY OF LANCASTER ) <br />lTorn�gne�a <br />(.76 Otitq /1 and <br />LISA A. BABKA - Transferor <br />‹YrP, Lcrhcls ✓1 <br />, the <br />witnesses, sign our names to this instrument, being first duly sworn, and do hereby declare to the <br />undersigned authority that the transferors sign and execute this transfer on death deed to transfer their <br />interest in the described real property and that they sign it willingly, and that they execute it as their free <br />and voluntary act for the purposes therein expressed, and that each of us, in the presence and hearing of <br />the transferors, hereby signs this deed as witness to the transferors' signing, and that to the best of his or <br />her knowledge the transferors are eighteen years of age or older or are not at this time minors and the <br />transferors are of sound mind and under no constraint or undue influence. <br />/Ida 04* A ).\(-0-. <br />Printed Name: ret\ ‘-A rd 01 <br />201704647 <br />Subscribed, sworn to, and acknowledged before me b1' Todd A. Babka and Lisa A. Babka, the <br />Transferors, and subscribed and sworn to before me by Cy1.. .c.-_P (,-o r o-c-d.c and <br />re ,k1 41 61 , witnesses, this 29t day of June, 2017. <br />Notary Public <br />