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202010091 WARNING The Department of Health and Human Services may require revocation of this Deed by a Transferor, or the Transferor's spouse, if any, or both a Transferor and the Transferor's spouse, if any, in order to qualify or remain qualified for Medicaid assistance. Executed this 15th day of December, 2020. We, Shane J. Burr and Kristen N. Burr, husband and wife, Transferor, sign our names to this instrument this 15th day of December, 2020, and being first duly sworn, do hereby declare to the undersigned authority that we sign and execute this Transfer on Death Deed to transfer our interest in the above described real property at the time of our death all in accordance with the Act, and that we sign it willingly or willingly direct another to sign for us, that we execute it as our free and voluntary act for the purposes therein expressed, that we are eighteen years of age or older or are not at this time a minor, and that we are of sound mind and under no constraint or undue influence. Burr, Transferor Kristen N. Burr, Transferor 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). We, (i_,�n..c\L-) �GLvp d Ci.. and Y11� (Vf(//eJ( , the witnesses, sign our names to this instrument, being first dhly sworn, do hereby declare to the undersigned authority that signs and executes this Transfer on Death Deed to transfer his or her interest in the above described real property at the time of the Transferor 's death and that he or she signs it willingly or willingly directs another to sign for him or her, and that he or she executes it as his or her free and voluntary act for the purposes therein expressed, and that each of us, in the presence and hearing of the Transferor, hereby signs this Transfer on Death Deed as witness to the Transferor's signing, and that to the best of his or her knowledge the Transferor is eighteen years of age or older or is not at this time a minor and the Transferor is of sound mind an. d o onstraint or undue influence. Subscribed, sworn husband and wife, and.,��', ) ss. to, and acknowledged before me by Shane J. Burr and Kristen N. Burr,Bur, Tran eror, and subscribed and sworn to before me by SCA � pN(C1 cehe witnesses, this 15th day of December, 2020. GENERAL NOTARY - State of Nebraska yew ELIZABETH G. BONIFAS 1`."+5 My Comm Exp. Sept. 10, 2021 Page 2 of 2