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I/ST 1023 0 I 1 2 8 RETURN TO: Barbara Jean Zapata 1515 Warbler Circle Grand Island, Nebraska 68803 TRANSFER ON DEATH DEED CASH CHECK /40 •0, REFUNDS: CASH CHECK HALL ;177 NE 2023 APa ° s . Q: LIS WOLD REGSfuEI' )r' In accordance with the provisions of the NEBRASKA UNIFORM REAL PROPERTY TRANSFER ON DEATH ACT, NEB. REV. STAT. §§ 76-3401 TO 76-3423 (the "Act"), Barbara Jean Zapata, (the "Transferor"), hereby states that upon the death of the Transferor, the following described real estate (as defined in NEB. REV. STAT. § 76-201): Lot One (1), Block Eighteen (18), University Place, an Addition to the City of Grand Island, Hall County, Nebraska more commonly referred to as 2032 N. Howard Street, Grand Island, Nebraska 68801, shall be transferred to McKenzie Zapata and Cadie Grim (the `Beneficiaries"), as joint tenants with rights of survivorship, in accordance with the terms and provisions of the Act. This Deed is revocable even if the Deed or another instrument contains a contrary provision. Pursuant to Neb. Rev. Stat. § 76-3414(5), this Deed conveys no legal or equitable interest in favor of any Beneficiary during the life of the Transferor. The Transferor states that the real estate described above is not agricultural land. WARNING The real property described above 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 Any designated Beneficiary above is personally liable, to the extent of the value of the real property transferred to the Beneficiary pursuant to this Deed, 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. Any designated Beneficiary above may also be personally liable, to the extent of the value of the real estate described above that is actually transferred to the Beneficiary pursuant to 1 of 2