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Name of Primary Beneficiary: Joseph T. Bartz Name of Alternate Beneficiary: NONE This Transfer on Death Deed is Revocable: Before my death, I have the right to revoke this deed. Growing Crops: If this land is agricultural land the growing crops shall pass to: My primary or alternate beneficiary _X_ My Estate I understand that if I make no choice, growing crops pass to my estate. Page 2 of 3 201803632 Mailing Address of Beneficiary: 3315 N. HWY 281, Grand Island, NE 68803 Mailing Address of Alternate Beneficiary: Transfer on Death: 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. Under Nebraska law the interest of a designated beneficiary is contingent on the designated beneficiary surviving the transferor by one hundred twenty (120) hours. Legally Required Warning in the Transfer on Death Deed: Please pay close attention to the following warnings: Warning: The property transferred remains subject to inheritance taxation in Nebraska to the same extent as if owned by the transferor at death. Failure to timely pay inheritance taxes is subject to interest and penalties as provided by law. Warning: The designated beneficiary is personally liable, to the extent of the value of the property transferred, to account for Medicaid reimbursement to the extent necessary to discharge any such claim remaining after application of the assets of the last surviving transferor's estate. The designated beneficiary may also be personally liable, to the extent of the value of the property transferred, for claims against the estate, statutory allowances to the last surviving transferor's surviving spouse and children, and the expenses of administration to the extent to pay such amounts by the personal representative. Warning: The Department of Health and Human Services may require revocation of this deed by a transferor, a transferor's spouse, or both a transferor and the transferor's spouse in order to qualify or remain qualified for Medicaid assistance.