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j799000Z0Z Return to: Berreckman, Davis & Bazata, P.C., L.L.O. PO Box 214 Cozad, NE 69130 REVOCABLE TRANSFER ON DEATH DEED (Single Owner) Notice to Owner You should carefully read all information on this form. You May Want to Consult a Lawyer before Using This Form. 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. Name of Owner Mailing Address of Owner Severiana Alvidrez 742 Locust Street, Cozad, NE 69130 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 Alternate Beneficiary as provided below. Lot Twelve (12), Houghkirk Subdivision, City of Grand Island, Hall County, Nebraska, EXCEPTING therefrom a Tract of land of Lot 12, conveyed to the Burlington Northern Railroad Company more particularly described as follows: Beginning at the Southwest corner of said Lot 12; thence running Northwesterly along the Westerly line of said Lot 12, a distance of 206.89 feet to the Northwest corner of said Lot 12; thence deflecting right 89°59'40" and running Northeasterly along the Northerly line of said Lot 12 a distance of 45.68 feet; thence deflecting right 89°30'31" and running Southeasterly a distance of 74.80 feet; thence deflecting right 90°28'49" and running Southwesterly a distance of 36.66 feet; thence deflecting left 90°6'59" and running Southeasterly a distance of 132.16 feet to a point on the Northerly right of way line of 12th Street; thence deflecting right 90°29'34" and running Southwesterly along the Northerly right of way line of 12th Street a distance of 10 feet to the point of beginning. Primary Beneficiary I designate the following beneficiary of this revocable transfer on death deed: Name of Primary Beneficiary Mailing Address of Primary Beneficiary Brenda Y. Ruiz 1208 Warren Lane, Grand Island, NE 68801 Alternate Beneficiary If my primary beneficiary does not survive me, I designate the following alternate beneficiary. Name of Alternate Beneficiary Mailing Address of Alternate Beneficiary Ruben Moreno Alvidrez Transfer on Death At my death, I transfer my interest in the described property to the beneficiaries as designated above. The transfer occurs at the death of the Transferor. N co N CD Q) CO ENTERED AS INSTRUMENT NO