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MST 1013 03249 REL., HALL C' 7073 ;01 CASH CHECK 12 .0° REFUNDS: CASH CHECK D E NE it: 12 %:fes? 1 ...1\ t _.. Q° Return to: Notice to Owner: Denise Myers, Attorne P.O. Box 505 Cairo, NE 68824 REVOCABLE TRANSFER ON DEATH DEED You should carefully read all information on this form. You may want to consult a Lawyer before using this Form. If you are married and both spouses do not sign this deed, the deed may be void. This form must be recorded with the Register of Deeds of the County in which the property is located before your death and it also must be recorded with the Register of Deeds of the County in which the property is located within 30 days after it was signed. If either of these requirements is not met, this form will not be effective. Identifying Information about Owner: Names of Owner: Mailing Address of Owner: Norman L. Bentley PO Box 308 Diana L. Bentley Cairo, NE 68824 Notice to Register of Deeds: This is a transfer on death deed and Form 521 is not required with the filing of this Transfer on Death deed under Neb. Rev. Stat. §76-214(2)(b). Legal Description: The following real estate is transferred by this document, effective at the death of the Owner to the Primary Beneficiary or to the appropriate Alternate Beneficiary as provided below. Lot One (1) and the Northerly Forty (N40) Feet of Lot Two (2), in Block Two (2), in Fifth Addition to the Town of Cairo, Hall County, Nebraska Primary Beneficiary: We designate the following beneficiaries of this revocable transfer on death deed if the beneficiaries survive the survivor of us. Name of Primary Beneficiary: Mailing Address of Primary Beneficiary: Wade E. Bentley Tamie P. Krolikowski Transfer on Death: PO Box 487 Cairo, NE 68824 691 Sunset Drive Dannebrog, NE 68831 At the death of the survivor of us, we transfer our interest in the described property to the beneficiaries as designated above. The transfer occurs at the death of the survivor of the Transferors. The beneficiaries shall own the property as tenants in common. Survivorship Required: Under Nebraska Law, the interest of a designated beneficiary is contingent on the designated beneficiary surviving the transferor by one hundred twenty (120) hours. This TOD Deed is Revocable: Before my death, I have the right to revoke this deed.