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242101912 <br />Name of Primary Beneficiary Mailing Address of Primary Beneficiary <br />DARLO R. BEAZLEY <br />1810 HWY 58 <br />DANNEBROG, NE 68832 <br />ANITA M. DAVIS 4334 ASTER DR. <br />GRAND ISLAND, NE 68803 <br />Transfer on Death <br />At my death, I transfer my interest in the described property to the beneficiaries as designated <br />above. The transfer occurs at the death of the Transferor. <br />Survivorship Required <br />Under Nebraska law, the interest of a designated beneficiary is contingent on the designated <br />beneficiary surviving the transferor by one hundred twenty hours. <br />This TOD Deed is Revocable <br />Before my death, I have the right to revoke this deed. <br />Required Warnings 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 <br />extent as if owned by the transferor at death. Failure to timely pay inheritance taxes is <br />subject to interest and penalties as provided by law. <br />Warning: <br />The designated beneficiary is personally liable, to the extent of the value of the property <br />transferred, to account for Medicaid reimbursement to the extent necessary to discharge <br />any such claim remaining after application of the assets of the transferor's estate. The <br />designated beneficiary may also be personally liable, to the extent of the value of the <br />property transferred, for claims against the estate, statutory allowances to the transferor's <br />surviving spouse and children, and the expenses of administration to the extent needed to <br />pay such amounts by the personal representative. <br />Warning: <br />The Department of Health and Human Services may require revocation of this deed by a <br />transferor, a transferor's spouse, or both a transferor and the transferor's spouse in order to <br />qualify or remain qualified for Medicaid assistance. <br />Signature of Owner Making This Transfer on Death Deed <br />, MARIETTA BEAZLEY, a single person, the transferor, sign my names to this instrument on <br />ah,r j 5 , 2021, and being first duly sworn, do hereby declare to the undersigned <br />authority that I sign and execute this transfer on death deed to transfer my interest in the described <br />Transfer on Death Deed - Page No. 2 <br />