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N <br />B <br />N <br />_ _ <br />HAL?_ r:''" " NE <br />CASH <br />CHECK /(4 lcD <br />REFUNDS: <br />CASH <br />CHECK <br />HIST 1023 01121 <br />RETURN TO: Barbara Jean Zapata <br />1515 Warbler Circle <br />Grand Island, Nebraska 68803 <br />TRANSFER ON DEATH DEED <br />11123 Aril H ;E, 0: I45 <br />'HOLD <br />REGISTER OF D EE' <br />In accordance with the provisions of the NEBRASKA UNIFORM REAL PROPERTY TRANSFER <br />ON DEATH ACT, NEB. REv. STAT. §§ 76-3401 TO 76-3423 (the "Act"), Barbara Jean Zapata, (the <br />"Transferor"), hereby states that upon the death of the Transferor, the following described real estate <br />(as defined in NEB. REv. STAT. § 76-201): <br />Lot Fourteen (14), Summerfield Estates Third Subdivision in the City of Grand Island, Hall County, <br />Nebraska <br />more commonly referred to as 1515 Warbler Circle, Grand Island, Nebraska 68803, <br />shall be transferred to McKenzie Zapata and Cadie Grim (the `Beneficiaries"), as joint tenants with <br />rights of survivorship, in accordance with the terms and provisions of the Act. <br />This Deed is revocable even if the Deed or another instrument contains a contrary provision. Pursuant <br />to Neb. Rev. Stat. § 76-3414(5), this Deed conveys no legal or equitable interest in favor of any <br />Beneficiary during the life of the Transferor. <br />The Transferor states that the real estate described above is not agricultural land. <br />WARNING <br />The real property described above remains subject to inheritance taxation in Nebraska to the same <br />extent as if owned by the Transferor at death. Failure to timely pay inheritance taxes is subject to <br />interest and penalties as provided by law. <br />WARNING <br />Any designated Beneficiary above is personally liable, to the extent of the value of the real property <br />transferred to the Beneficiary pursuant to this Deed, to account for Medicaid reimbursement to the <br />extent necessary to discharge any such claim remaining after application of the assets of the <br />Transferor's estate. Any designated Beneficiary above may also be personally liable, to the extent of <br />the value of the real estate described above that is actually transferred to the Beneficiary pursuant to <br />this Deed, for claims against the Transferor's estate, statutory allowances to the Transferor's surviving <br />1 of 2 <br />