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INST 1073 02334 <br />CASH <br />CHECK Q.9-00 <br />oD <br />REFUNDS: <br />CASH <br />CHECK, <br />.HECL1 \LED <br />HALL C C J E Y NE <br />1013 1iY ' 2 `': 20 <br />K ,3t WOLD • <br />REGISTER OF D ELY <br />Return to: <br />Kevin P. Walsh <br />Smith Johnson Law Firm <br />104 N. Wheeler Avenue <br />Grand Island, NE 68801 <br />REVOCABLE TRANSFER ON DEATH DEED <br />(Joint Tenants) <br />Notice to Owners <br />You should carefully read all information on this form. <br />This transfer on death deed must be recorded with the Register of Deeds of the County in which <br />the property is located, before your deaths and within 30 days after being signed. If either of these <br />requirements is not met, this transfer on death deed will not be effective. <br />Identifying Information about Owners <br />Name of Owners Mailing Address of Owners <br />Ervin A. Woltman and Dorothy A. <br />Woltman, husband and wife as joint <br />tenants with rights of survivorship <br />1904 W. 11th Avenue <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 deaths of the Owners, to <br />the Beneficiary as provided below. <br />Lot Sixteen (16) in Block Five (5) in Boggs and Hill's Addition to the City of Grand <br />Island, Hall County, Nebraska. <br />Beneficiary <br />We designate the following beneficiaries of this revocable transfer on death deed if the <br />beneficiaries survives both of us. <br />Name of Beneficiary <br />Janice M. Chambers <br />Kirk A. Woltman <br />Misty A. Woltman <br />Cindy K. O'Connell <br />Mailing Address of Beneficiary <br />9681 E. 124th Street N. <br />Collinsville, OK 74021 <br />2641 N. 131' Circle <br />Omaha, NE 68164 <br />1512 N. Grand Island Avenue <br />Grand Island, NE 68803 <br />424 E. 19th Street <br />Grand Island, NE 68801 <br />Page 1 of 3 <br />