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201807450 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 transferor's estate. The designated beneficiary may also be personally liable, to the extent ofthe value ofthe property transferred, for claims against the estate, statutory allowances to the transferor's surviving spouse and children, and the expenses of administration to the extent needed 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. We, Mich el I. Broadway and Sheryl L. Broadway, the transferors, sign our names to this instrument this day of November, 2018, and being first duly sworn, do hereby declare to the undersigned authority that we sign and execute this transfer on death deed to transfer our interest in the described real property and that we sign it willingly, that we execute it as our free and voluntary act for the purposes therein expressed, that we are eighteen years of age or older or are not at this time a minor, and that we are of sound mind and under no constraint or undue influence. MIC AEL L BROADWAY — Transferor i SHERYLnDWAY - Transferor We, CA OhC and 16,r O it\ the witnesses, sign our names to this instrument, being first duly sworn, and do hereby declare to the undersigned authority that the transferors sign and execute this transfer on death deed to transfer their interest in the described real property and that they sign it willingly, and that they execute it as their free and voluntary act for the purposes therein expressed, and that each of us, in the presence and hearing of the transferors, hereby signs this deed as witness to the transferors' signing, and that to the best of his or her knowledge the transferors are eighteen years of age or older or are not at this time minors and the transferors are of sound mind and under no constraint or undue influence. Printed Name: ! "� 6. 1 1 2 STATE OF NEBRASKA ) ) ss. COUNTY OF LANCASTER ) Printed Name: /\-tire--1 LQ nc00r1 Subscribed, sworn to, and acknowledged before me by Michael I. Broadway and Sheryl L. Broadway, the Transferors, and subscribed d sworn to before me by eV\ B.O 1+C- and re, La O witnesses, this 2.- day of November, 2018. GENERAL NOTARY - State of Nebraska CHRISTOPHER S. BARTLING My Comm. Exp. June 27, 2021 Notary Public