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202101810 <br />Legally Required Warning in the TOD Deed: <br />Please pay close attention to the following warnings: <br />Warning: <br />The property transferred remains subject to inheritance taxation in Nebraska to the same extent as <br />if owned by the transferor at death. Failure to timely pay inheritance taxes is subject to interest and <br />penalties as provided by law. <br />Warning: <br />The designated beneficiary is personally liable, to the extent of the value of the property transferred, <br />to account for Medicaid reimbursement to the extent necessary to discharge any such claim <br />remaining after application of the assets of the last surviving transferor's estate. The designated <br />beneficiary may also be personally liable, to the extent of the value of the property transferred, for <br />claims against the estate statutory allowances to the last surviving transferor's surviving spouse and <br />children, and the expenses of administration to the extent needed to pay such amounts by the <br />personal representative. <br />Warning: <br />The Department of Health and Human Services may require revocation of this deed by a transferor, <br />a transferor's spouse, or both a transferor and the transferor's spouse in order to qualify or remain <br />qualified for Medicaid assistance. <br />Signature of Owner Making This Transfer on Death Deed: <br />I, Linda Hird, the transferor(s), sign my name to this instrument on _ 1 , 2021, and being first duly <br />sworn, do hereby declare to the undersigned authority that I sign and execute this transfer on death deed to transfer <br />my interest in the described real property and that I sign it willingly, that I execute it as my free and voluntary act for the <br />purposes therein expressed, that I am eighteen years of age of older or am not at this time a minor, and that I am of <br />sound mind and under no constraint or undue influence. <br />Linda Hird, Transferor <br />Warning: <br />The two witnesses must be disinterested for this Deed to be valid. Interested witness means any individual who on <br />the date that this deed is executed is or would be entitled to receive any interest in the land if the transferor died under <br />the circumstances existing at the date of the signing of this deed. <br />We, /" I tc h.Ae.I —0.-e Ls c and 401- � o li f , the witnesses, sign our <br />names to this instrument, being first duly sworn, and do hereby declare to the undersigned authority that the transferor <br />signs and executes this transfer on death deed to transfer his or her interest in the described real property and he or <br />she signs it willingly or willingly directs another to sign for him or her, and that he or she executes it as their free and <br />voluntary act for the purposes therein expressed, and the each of us, in the presence and hearing of the transferor, <br />hereby signs this deed as a witness to the transferor's signing , and that to the best of our knowledge the transferor <br />is eighteen years of age or older or is not at this time a minor and the transferor is of sound mind and under no constraint <br />or undue influence. <br />Witness <br />Witness <br />STATE OF NEBRASKA <br />) ss <br />COUNTY OF HALL <br />e -A 14 <br />Address of Witness <br />yv3 .S 1517 - <br />Liz & (—/ <br />1 <br />iiz&oay <br />Address of Witness <br />Subscribed, sworn to, ndiacknowledged before me by Linda Hird,,a single person, transferor, and subscribed <br />and sworn to before me by 1fi .J o' -I -DieSShe/' , and Lor, &pl;nq , witnesses, on <br />3/1,2021. J <br />GENERAL NOTARY - State of Nebraska <br />DENISE D. MYERS <br />My Comm. Exp. November 20, 2022 <br />... <br />Notary Public <br />