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Ince recorded, return to: Downing, Alexander & Wood PO Box 744, Kearney, NE 68848-0744 REVOCABLE TRANSFER ON DEATH DEED (Single Owner) Notice to Owner: You should carefully read all information on this form. You May Want to Consult a Lawyer before Using This Form. This form must be recorded with the Register of Deeds of the county in which the property is located before your death and it also must be recorded with the Register of Deeds of the county in which the property is located within 30 days after it was signed. If either of these requirements is not met, this form will not be effective. Identifying Information about Owner(s): Name of Owner Alberta M. Wiese, a single person Notice to Register of Deeds: Mailing Address of Owner 408 Kennedy Drive Grand Island, NE 68803 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). Legal Description: The following real estate is transferred by this document, effective at the death of Owner, to the Primary Beneficiaries as provided below. Lot Nineteen (19), Wolfe's Subdivision, in the City of Grand Island, Hall County, Nebraska Primary Beneficiaries: I designate the following named beneficiaries to receive the real estate covered by this Revocable Transfer on Death Deed if the beneficiaries survive me, in equal shares: Name of Primary Beneficiary Marvin R. Wiese Name of Primary Beneficiary Calvin L. Wiese Mailing Address of Primary Beneficiary 8115 S. Nine Bridge Road Doniphan, NE 68832 Mailing Address of Primary Beneficiary 411 Kennedy Drive Grand Island, NE 68803 0