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202300514 This TOD Deed is Revocable Before my deaths, I have the right to revoke this deed. Legally Required Warnings in the TOD Deed: Please pay close attention to the following warnings. Warning: 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. Warning: The designated beneficiaries are 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 transferor's estate. The designated beneficiaries may also be personally liable, to the extent of the value of the property transferred, for claims against the estate, statutory allowances to the transferor's surviving spouse and children, and the expenses of administration to the extent needed to pay such amounts by the personal representative. Warning: 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 for Medicaid assistance. Signature of Owner Making This Transfer on Death Deed I Jeanette P. Moe, the transferor, sign our names to this instrument on l — 3 20a , and being first duly sworn, do hereby declare to the undersigned authority that I sign and execute this transfer on death deed to transfer my interest in the described real property and that I sign it willingly or willingly direct another to sign for me, that I execute it as my free and voluntary act for the purposes therein expressed, that I am eighteen years of age or older or are not at this time minors, and that I am of sound mind and under no constraint or undue influence. Aviatv P. Mitt; Je ette P. Moe, Transferor Warning: The two witnesses must be disinterested for this Deed to be valid. An interested witness means any individual who, on the date of this deed, is or would be entitled to receive any interest in the land under this transfer on death deed if the transferor died under the circumstances existing at the date of the signing of this deed, or any child, spouse, or heir of that person. We, "Cr/ 'Vr 89,g7lit. ' and toy (600 , the witnesses, sign our names to this instrument, being first duly sworn, and do hereby declare to the undersigned authority that the transferor sign and execute this transfer on death deed to transfer her interest in the described real property and that she signs it willingly or willingly direct another to sign for her, and that she execute it as her free and voluntary act for the purposes therein expressed, and that each of us, in the presence and hearing of the transferor, hereby signs this deed as witness to the transferors' signing, and that to the best of his or her knowledge the transferor is eighteen years of age or older or are not at this time minors and the transferor is of sound mind and under no constraint or undue influence. 7336 Witness Address 4duo_4;41Ped> 683 Witness Address Page 2 of 3 6,00