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Return to: enise Myers, Attorney <br />O. Box 505 <br />Cairo, NE 68824 <br />Notice to Owner: <br />Name of Primary Beneficiaries: <br />Christie L. Schreiber <br />Randal R. Eilts <br />Brenda S. Roth <br />Laurie L. Clark <br />Melissa J. Schultz <br />Contingent Beneficiaries: <br />Rebecca L. Schreiber <br />Elizabeth C. Schreiber <br />Danielle M. Schreiber <br />REVOCABLE TRANSFER ON DEATH DEED <br />You should carefully read all information on this form. You may want to consult a Lawyer before using this Form. If you <br />are married and both spouses do not sign this deed, the deed may be void. <br />This form must be recorded with the Register of Deeds of the County in which the property is located before your death <br />and it also must be recorded with the Register of Deeds of the County in which the property is located within 30 days <br />after it was signed. If either of these requirements is not met, this form will not be effective. <br />Identifying Information about Owner: <br />Names of Owner: Mailing Address of Owner: <br />Barbara L. Eilts 4177 Mason Ave. <br />(a single person) Grand Island, NE 68803 <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 Death deed under Neb. <br />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 Owner to the Primary Beneficiary <br />or to the appropriate Alternate Beneficiary as provided below. <br />Lot Three (3), Sunset Seventh Subdivision, Hall County, Nebraska. <br />Primary Beneficiaries: <br />I designate the following beneficiaries of this revocable transfer on death deed if the beneficiaries survive me: <br />Mailing Address of Primary Beneficiaries: <br />1812 226t Eagle, NE 68347 <br />824 Faith Trail, Heath, TX 75032 <br />2253 Brookhill Drive, Camarillo, CA 93010 <br />600 S. Jackson, Brenham, TX 77833 <br />1209 Fox Run Trail, Platte City, MO 75032 <br />If Christie L. Schreiber should predecease me her share shall pass to: <br />1812 226 Eagle, NE 68347 <br />1812 226 Eagle, NE 68347 <br />1812 226` Eagle, NE 68347 <br />If Randal R. Eilts should predecease me his share shall pass to: <br />Jonathan R. Eilts 824 Faith Trail, Heath, TX 75032 <br />Jennifer G. Eilts 824 Faith Trail, Heath, TX 75032 <br />James W. Eilts 824 Faith Trail, Heath, TX 75032 <br />If Brenda S. Roth should predecease me her share shall pass to: <br />Nathan A. Roth 2253 Brookhill Drive, Camarillo, CA 93010 <br />Aaron M. Roth 2253 Brookhill Drive, Camarillo, CA 93010 <br />Mikaela M. Roth 2253 Brookhill Drive, Camarillo, CA 93010 <br />If Laurie L. Clark should predecease me her share shall pass to: <br />Thomas E. Clark 219 Sunflower Dr., Kyle, TX 76073 <br />Emily J. Clark 219 Sunflower Dr., Kyle, TX 76073 <br />