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UJ 1■110i■11111 1■11.i.1■111 Return to: Bruce I. Smith 104 N. Wheeler Avenue Grand Island NE 68801 Identifying Information about Owner(s) Name of Owner Garry E. Meyer X _ c n= m z x m > v n t/ • 0) REVOCABLE TRANSFER ON DEATH DEED Notice to Owner You should carefully read all information on this form. Name of Primary Beneficiaries Melissa J. Howes Page 1 of 3 Mailing Address of Owner 2309 Lakewood Circle Grand Island, NE 68801 Unit Four (4), Oakwood Condominiums in the City of Grand Island, Hall County, Nebraska. Timothy A. Meyer 925 S. 199th Street Elkhorn, Nebraska 68022 This transfer on death deed must be recorded with the Register of Deeds of the County in which the property is located, before your death and within 30 days after being signed. If either of these requirements is not met, this transfer on death deed will not be effective. 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 Alternate Beneficiary as provided below. Primary Beneficiaries I designate the following beneficiaries of this revocable transfer on death deed if the beneficiary survives me. Mailing Address of Primary Beneficiaries 340 E Aspen Circle Sioux Falls, South Dakota 57105 Contingent Beneficiaries If Primary Beneficiary Melissa J. Howes fails to survive me, I designate the then surviving issue of said Melissa J. Howes by right of representation to receive the interest of Melissa J. Howes in the subject real estate had she survived me. If Primary Beneficiary Timothy A. Meyer fails to survive me, I designate the then surviving issue of said Timothy A. Meyer by right of representation to receive the interest of Timothy A. Meyer in the subject real estate had he survived me.