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Return to: Denise Myers, Attorney ✓P.O. Box 505 Cairo, NE 68824 Notice to Owner: Primary Beneficiary: Wesley A. Wellensiek Michael S. Wellensiek Transfer on Death: Survivorship Required: This TOD Deed is Revocable: Before my death, I have the right to revoke this deed. REVOCABLE TRANSFER ON DEATH DEED 5145 West Valley Road Hastings, NE 68901 8036 Centaur Drive Evergreen, CO 80437 Cr) rri C) r "C "wS F :() Cr) ;"I„ 1 71 C3J r- - 1 — N.) ;7 CD _.. W C!3 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: Charles H. Wellensiek P.O. Box 513 Marilyn K. Wellensiek Cairo, NE 68824 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 Beneficiary or to the appropriate Alternate Beneficiary as provided below. The East Twenty -five Feet (E25') of Lot Four (4) and the South One Hundred Ninety -three Feet (S193') of Lot Three (3), Block One (1), Ingalls - Turner Subdivision, in the Village of Cairo, Hall County, Nebraska, excepting a certain tract more particularly described in Joint Tenancy Warranty Deed recorded as Document No. 82- 003641. We designate the following beneficiaries of this revocable transfer on death deed if the beneficiaries survive the survivor of us. Name of Primary Beneficiary: Mailing Address of Primary Beneficiary: 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.