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Return to: Denise Myers, Attorney J.O. Box 505 Cairo, NE 68824 Notice to Owner: Primary Beneficiary: Survivorship Required: po nn 0) rn = > Cr) C r= =nv rn n vt n vi •• X = REVOCABLE TRANSFER ON DEATH DEED N rya N rr r ;,T3 (J) You should carefully read all information on this form. You may want to consult a Lawyer before using this Form. If you are married and both spouses do not sign this deed, the deed may be void. 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. Identifying Information about Owner: Names of Owner: Mailing Address of Owner: Larry D. McAhren 6140 Wildwood Drive Alda, NE 68810 Notice to Register of Deeds: 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). Legal Description: The following real estate is transferred by this document, effective at the death of the Owner to the Primary Beneficiaries or to the appropriate Alternate Beneficiary as provided below. The Southeast Quarter of the Southeast Quarter (SE1 /4SE 1 /4) of Section Twenty -eight (28), Township Eleven (11) North, Range Ten (10), West of the 6` P.M., Hall County, Nebraska, EXCEPT that part conveyed to the State of Nebraska in the Deed recorded in Book 82 at page 499 of the Deed Records of Hall County, Nebraska. Lot One (1), in Block Ninety Nine (99), in Railroad Addition to the City of Grand Island, Hall County, Nebraska. Lot Six (6), Block Eight (8), Kernohan and Decker's Addition to the City of Grand Island, Hall County Nebraska. Fractional Lots One (1), Two (2) and Three (3), in Fractional Block Thirteen (13), in Fairview Park Addition to the City of Grand Island, Hall County, Nebraska, EXCEPTING THEREFROM the Northerly Seventy and Seven Tenths (70.7) Feet of Fractional Lots One (1) and Two (2), in said Fractional Block Thirteen (13), in Fairview Park Addition. I designate the following beneficiaries of this revocable transfer on death deed if the beneficiaries survive me: Name of Primary Beneficiaries: Mailing Address of Primary Beneficiaries: Allison Spiehs 3904 Kimos Circle, Lawrence, KS 66049 Jessica Friesz 1012 Coveview Circle, Oak Harbor, WA 98277 Transfer on Death: At my death I transfer my interest in the described property to the beneficiaries as designated above, as tenants in common. The transfer occurs at the death of Larry D. McAhren. Under Nebraska Law, the interest of a designated beneficiary is contingent on the designated beneficiary surviving the transferor by one hundred twenty (120) hours. 1 0