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Name of Primary Beneficiaries 202102713 Mailing Address of Primary Beneficiaries William D. Gellatly 25409 Thoreau W. Stevenson Ranch, CA 91381 Sean D. Gellatly 3080 W. Cedarview Rd. Doniphan, NE 68832 Travis R. Gellatly 2209 N. 176th Ave. Omaha, NE 68116 Alternate Beneficiary - none We understand that if one or more of the above beneficiaries dies before us, then at our death the property will only go to those named above who survive us. Drew R. Gellatly init Minnie M. Gellatly initials Transfer on Death At the death of the survivor of us, we transfer our interest in the described property to the beneficiaries as designated above. The transfer occurs at the death of the survivor of the Transferors. Survivorship Required Under Nebraska law, the interest of a designated beneficiary is contingent on the designated beneficiary surviving the survivor of the Transferors by one hundred twenty (120) hours. This Transfer on Death Deed is Revocable Before our death, we (or the sun ivor of us) have the right to revoke this Deed. Growing Crops - If this land is agricultural land the growing crops shall pass to: ❑ The Primary or Alternate beneficiary 0 The estate of the survivor of us We understand that if we make no choice growing crops pass to the estate of the survivor of us. Legally Required Warnings in the Transfer on Death Deed: Please pay close attention to the following warnings: 1) The property transferred remains subject to inheritance taxation in Nebraska to the same extent as if owned by the Transferor at death. Failure to timely pay inheritance taxes is subject to interest and penalties as provided by law. 2) The designated beneficiary is personally liable, to the extent of the value of the property transferred, to account for Medicaid reimbursement to the extent necessary to discharge any such claim remaining after application of the assets of the last surviving Transferor's estate. The designated beneficiary may also be personally liable, to the extent of the value of the property transferred, for claims against the estate, statutory allowances to the last -surviving Transferor's surviving spouse and children, and the expenses of administration to the extent needed to pay such amounts by the personal representative. 3) The Department of Health and Human Services may require revocation of this Deed by a Transferor, a Transferor's spouse, or both a Transferor and the Transferor's spouse in order to qualify or remain qualified by Medicaid assistance. Page 2 of 3