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202303231 <br />Survivorship Required <br />Under Nebraska law, the interest of a designated beneficiary is contingent on the designated <br />beneficiary surviving the transferor by one hundred twenty hours. <br />Growing Crops <br />If there are growing crops on this land at the time of transfer, my rights to those crops are <br />transferred to the beneficiaries herein. <br />This TOD Deed is Revocable <br />Before my death, I have the right to revoke this deed. <br />Legal Warnings: <br />Please pay close attention to the following warnings: <br />A. The property transferred remains subject to inheritance taxation in Nebraska to the <br />same extent as if owned by the transferor at death. Failure to timely pay inheritance taxes is <br />subject to interest and penalties as provided by law. <br />B. The designated beneficiary is personally liable, to the extent of the value of the <br />property transferred, to account for Medicaid reimbursement to the extent necessary to discharge <br />any such claim remaining after application of the assets of the transferor's estate. The designated <br />beneficiary may also be personally liable, to the extent of the value of the property transferred, <br />for claims against the estate, statutory allowances to the transferor's surviving spouse and <br />children, and the expenses of administration to the extent needed to pay such amounts by the <br />personal representative. <br />C. The Department of Health and Human Services may require revocation of this deed by <br />a transferor, a transferor's spouse, or both a transferor and the transferor's spouse in order to <br />qualify or remain qualified for Medicaid assistance. <br />Signature of Owner Making This Transfer on Death Deed <br />I, Beverly J. Wildauer, the transferor, sign my name to this instrument on June %.D <br />2023, and being first duly sworn, do hereby declare to the undersigned authority that I sign and <br />execute this transfer on death deed to transfer my interest in the described real property and that I <br />sign it willingly, that I execute it as my free and voluntary act for the purposes therein expressed, <br />that I am eighteen years of age or older or am not at this time a minor, and that I am of sound <br />mind and under no constraint or undue influence. <br />Beverly J. Wilda r, <br />Transferor <br />lJAciconnU <br />(Warning: The two witnesses must be disinterested for this Deed to be valid. An interested <br />witness means any individual who on the date that this deed is or would be entitled to receive <br />any interest in the land if the transferor died under the circumstances existing at the date of the <br />signing of this deed.) <br />We, Mary Hollowell and Peachis Amadou the witnesses, sign our names to this instrument, <br />being first duly sworn, and do hereby declare to the undersigned authority that the transferor <br />signs and executes this transfer on death deed to transfer his or her interest in the described real <br />property and that he or she signs it willingly or willingly, and that he or she executes it as his or <br />her free and voluntary act for the purpose therein expressed, and that each of us, in the presence <br />and hearing of the transferor, hereby signs this deed as witness to the transferor's signing, and <br />that to the best of his or her knowledge the transferor is eighteen years of age or older or is not at <br />this time a minor and the transferor is of sound mind and under no constraint or undue influence. <br />gb-0-5W•04_Grand Island, NE <br />Witness' NamWitness' Address <br />e <br />2 <br />