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73 <br />11 <br />N- -11C <br />ti <br />e� m > V <br />-.1 _ <br />B <br />7-70 <br />l) -..! <br />r:i - :13c.) <br />c. r - <br />(r <br />G7 <br />Return to: Jamie Mues Jankovitz <br />/202 W. 3"' St. <br />Grand island, NE 68801 <br />REVOCABLE TRANSFER ON DEATH DEED <br />CO <br />Notice to Owner <br />You should carefully read all information on this form. You may want to consult a Lawyer before <br />using this form. <br />This form must be recorded with the Register of Deeds of the county in which the property is <br />located before your death and it also must be recorded with the Register of Deeds of the County in which <br />the property is located within 30 days after it was signed. If either of these requirements is not met, this <br />form will not be effective. <br />Identifying Information about Owners <br />Name of Owner <br />Shirley F. Wolzen, a single person <br />Mailing Address of Owner <br />718 Sweetwood Dr. <br />Grand Island, NE 68803 <br />Notice to Register of Deeds <br />This is a transfer on death deed and Form 521 is not required with the filing of this Transfer on <br />Death Deed under Neb. Rev. Stat. §76-214 (2) (b). <br />Legal Description <br />The following real estate is transferred by this document, effective at the death of the Owner to <br />the Primary Beneficiaries as provided below. <br />Lot Thirteen (13), Westwood Park Subdivision, in the City of Grand Island, Hall <br />County, Nebraska. (Physical Address: 718 Sweetwood Dr., Grand Island, NE) <br />Primary Beneficiaries <br />1 designate the following beneficiaries of this revocable transfer on death deed if the beneficiaries <br />survive me. <br />Names of Primary Beneficiary's Mailing address of Prirnary Beneficiary <br />An undivided 1/3 interest to <br />Tracey & Elizabeth Wolzen, 1349 S. Pine St. <br />husband and wife, JTWROS; and Ottawa, KS 66067 <br />An undivided 1/3 interest to <br />Marlin Seyler, a single person; 3923 Meadow Way Trail <br />and Grand Island, NE 68803 <br />An undivided 1/3 interest to <br />Thomas Ott, a single person <br />808 W. 14''' St. <br />Box 8 <br />McCook, NE 69001 <br />the fractional interests to be owned as tenants in common. <br />Transfer on Death <br />At my death. I transfer my interest in the described property, to the beneficiaries as designated <br />above. The transfer occurs as of the date of my death. <br />Survivorship Required <br />Under Nebraska law, the interest oldie designated beneficiary is contingent on the designated <br />beneficiary surviving the transferor by one hundred twenty (120) hours. <br />This TOD is Revocable <br />Page 1 of 2 <br />