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Return to: <br />Ronald S. Depue <br />308 N. Locust, Ste. 501 <br />Grand Island, NE 68801 <br />IHST 1123 0 0 910 <br />CHECK F•4.40 <br />REFUNDS: <br />CASH <br />CHECK <br />HALE COU NE <br />RIM 14AR -2 <br />K RI ST <br />REGISTER OF DE <br />51 <br />Space Above Line Reserved for Recording Purposes <br />REVOCABLE TRANSFER ON DEATH DEED <br />Notice to Owner <br />You should carefully read all information on this form. You May Want to Consult a Lawyer before <br />Using This Form. <br />This form must be recorded with the Register of Deeds of the County in which the property is <br />located before your death and it also must be recorded with the Register of Deeds of the County <br />in which the property is located within 30 days after it was signed. If either of these requirements <br />is not met, this form will not be effective. <br />Identifying Information about Owner(s) <br />Name of Owner <br />MARY K. CHAPMAN 2705 O'FLANNAGAN <br />GRAND ISLAND, NE 68803 <br />Notice to Register of Deeds <br />This is a transfer on death deed and Form 521 is not required with the filing of this Transfer on <br />Death deed under Neb. Rev. Stat. §76-214(2)(b). <br />Legal Description <br />The following real estate is transferred by this document, effective at the death of the Owner to the <br />Primary Beneficiary or to the Alternate Beneficiary as provided below. <br />N 110' of Lot 6, Block 3, Dickey Second Subdivision, Grand Island, Hall County, <br />Nebraska <br />Transfer on Death Deed - Page No. 1 <br />