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Once recorded, return to: Thomas A. Emerton P.O. Box 40 Cairo, NE 68824 Notice to Owner: Identifying Information about Owner: Names of Owner: Mailing Address of Owner: Terry P. Gallagher and Rita A. Gallagher Husband and wife Notice to Register of Deeds: Legal Description: Transfer on Death: 1 REVOCABLE TRANSFER ON DEATH DEED P.O. Box 100. Cairo, NE 68824 CX'' N CJ C/1 (71 r J You should 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 Deeds 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. 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). The following real estate is transferred by this document, effective at the death of the Owners to the Primary Beneficiary or to the appropriate Alternate Beneficiary as provided below. Lots 5 and 6, Block 4, Fourth Addition to the Village of Cairo, Hall County, Nebraska Primary Beneficiary: We designate the following beneficiary of this revocable transfer on death deed if the beneficiary survives the survivor of us. Name of Primary Beneficiary: Mailing Address of Primary Beneficiary: Tamara A. Work 419 Orleans Lane Grand Island, NE 68803. Name of Alternate Beneficiary: Mailing Address of Alternate Beneficiary: Todd M. Gallagher 82703 Grouse Lane, Burwell, NE 68823 At the death of the survivor of us, we transfer our interest in the described property to the beneficiaries as designated above. The transfer occurs at the death of the survivor of the Transferors.