Laserfiche WebLink
m <br />T1 <br />c <br />z <br />v <br />X = vs <br />(I ("1 7,- <br />= D cn --+ <br />nN <br />= <br />xI <br />73 7C <br />r 0 :77 <br />CP -4 <br />RI :IC <br />rTi <br />REVOCABLE TRANSFER ON DEATH DEED <br />c v <br />--I rn <br />C, <br />NOTICE TO OWNER: <br />You should carefully read all information on this form. If you are married and both <br />spouses do not sign this deed, the deed may be void. <br />WARNING: The property transferred remains subject to inheritance taxation in <br />Nebraska to the same extent as if owned by the transferor at death. Failure to timely <br />pay inheritance taxes is subject to interest and penalties as provided by law. <br />WARNING: The designated beneficiaries are personally liable, to the extent of the <br />value of the property transferred, to account for Medicaid reimbursement to the extent <br />necessary to discharge any such claim remaining after application of the assets of the <br />transferor's estate. The designated beneficiaries may also be personally liable, to the <br />extent of the value of the property, for claims against the estate, statutory allowances to <br />the transferor's surviving spouse and children, and the expenses of administration to the <br />extent needed to pay such amounts by the personal representative. <br />WARNING: The Department of Health and Human Services may require revocation of <br />this deed in order to qualify for Medicaid assistance. This form must be recorded before <br />your death, or it will not be effective. <br />IDENTIFYING INFORMATION <br />Owner Making This Deed: <br />Chi Thi Lan Le <br />412 N. Grace Avenue <br />Grand Island, NE 68803 <br />LEGAL DESCRIPTION OF THE PROPERTY <br />Lot One Hundred Twenty-six (126), in Belmont Addition, an Addition to the <br />City of Grand Island, Hall County, Nebraska. <br />PRIMARY BENEFICARY <br />I designate the following beneficiary: <br />Truc L.T. Nguyen <br />412 N. Grace Avenue <br />Grand Island, NE 68803 <br />1 <br />ON 1N3Wf LLSN <br />