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l <br />(Th4k <br />& 2Q6 n -Ti <br />N <br />N� I r.„ Z P C1=.. <br />e L <br />w�� <br />,, V- -'' I li <br />cq <br />REVOCABLE TRANSFER ON DEATH DEED <br />NOTICE TO REGISTER OF DEEDS: This document REVOKES the Revocable <br />Transfer on Death Deed recorded on July 15, 2020, as Document No. 202004962 <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 />Robert Carl Stueven, joined in by Hazel Margene Stueven, his Wife <br />506 N. Lone Pine <br />Springfield, MO 65802 <br />1 <br />7O <br />C <br />rn <br />00 <br />