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n r <br />= D <br />mN <br />Cr) <br />c: <br />_--4 i,1 <br />N <br />Cf <br />N <br />fti <br />r1 N <br />CJS H <br />Return to: <br />Brandon S. Connick <br />Smith Johnson Law Firm <br />104 N. Wheeler Avenue <br />Grand Island, NE 68801 <br />REVOCATION OF TRANSFER ON DEATH DEED <br />Notice to Owner <br />This revocation must be recorded with the Register of Deeds of the County in which the property <br />is located and it also must be recorded with the Register of Deeds of the County in which the <br />property is located before the death of the signer(s) and also within 30 days after it was signed or <br />it will not be effective. This revocation is effective only as to the interests in the property of <br />owners who sign this revocation. <br />Identifying Information <br />Name of Owner <br />Jack E. Rasmussen <br />Mailing Address of Owner <br />557 Stagecoach Road <br />Grand Island, NE 68803 <br />Notice to Register of Deeds <br />This is a revocation of transfer on death deed and Form 521 is not required under Neb. Rev. Stat. <br />§76-214(2). <br />Legal Description <br />Suite One (1), Fairway Estates Condominium Property Regime 1, in the City of <br />Grand Island, Hall County, Nebraska <br />Revocation <br />I revoke that transfer on death deed dated March 24, 2016 and recorded on April 20, 2016, as <br />Instrument No. 201602349 at the Office of the Register of Deeds of Hall, County Nebraska <br />which affects the above d scribed real estate is revoked by this document. <br />Ja• E. Rasmussen, ransferor <br />We, —1c -A,1 111. e and d 1.6# r_/2._ , the <br />witnesses, sign our names to this instrument, being first duly sworn, and do hereby declare to the <br />undersigned authority that the transferor signs and executes this revocation of transfer on death <br />deed to revoke his interest in the described real property and that he signs it willingly or <br />willingly directs another to sign for him, and that he executes it as his free and voluntary act for <br />the purposes therein expressed, and that each of us, in the presence and hearing of the transferor, <br />hereby signs this revocation of transfer on death deed as witness to the transferor's signing, and <br />Revocation of Transfer on Death Deed - Page No. 1 <br />ow iw wMIiSN <br />