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6.. F w P F Cv °%) n r,i 0 W C7 CO CT) REVOCABLE TRANSFER ON DEATH DEED CD N s N O NOTICE TO OWNER: You should carefully read all information on this form. If you are married and both spouses do not sign this deed, the deed may be void. 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 beneficiaries are 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 beneficiaries may also be personally liable, to the extent of the value of the property, 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 in order to qualify for Medicaid assistance. This form must be recorded before your death, or it will not be effective. IDENTIFYING INFORMATION Owner Making This Deed: John H. Aldana 907 E. 7th Street Grand Island, NE 68801 LEGAL DESCRIPTION OF THE PROPERTY The easterly thirteen and two tenths (132) feet of fractional lot four (4), and the westerly twenty-nine and eight tenths (29.8') feet of fractional lot three (3), fractional block seven (7), all in Lambert's Addition, also known as John W. Lambert's Addition; and the westerly forty-three (43) feet of fractional lot four (4), fractional block two (2), in Evans Addition, all in the City of Grand Island, Hall County, Nebraska. AND A tract of land comprising the easterly 18.2' of fractional lot three (3), all of fractional lot ten 10 , and the westerly 12.0' of fractional lot two (2), all in fractional block seven (7) in John W. Lambert's Addition; and the easterly 9.8' of fractional lot four (4) and the westerly 38.4' of fractional lot three (3), all in fractional block two (2), Evans Addition; all in the City of Grand Island, Hall County, Nebraska, being the Intention to be a tract of land 48.2' in width east and west, and 132.0' in length north and south, the easterly line of which lies 120.0' westerly from and parallel to the westerly line of Evans Addition, in the City of Grand Island, Hall County, Nebraska. 1 1 rri0 r -n 0