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202303251 The Department of Health and Human Services may require revocation of this deed by a transferor, a transferor's spouse, or both a transferor and the transferor's spouse in order to qualify or remain qualified for Medicaid assistance. We, Gerain L. Spatz and Laura M. Spatz, Husband and Wife, the Owners, sign our names to this instrument on June 20, 2023, and being first duly sworn, do hereby declare to the undersigned authority that we sign and execute this transfer on death deed to transfer our interest in the described real property and that we sign it willingly or that one or both of us willingly direct another to sign for that signer or signers, that we execute it as our free and voluntary act for the purposes therein expressed, that we are eighteen years of age or older or are not at this time a minor, and that we are of s•und and under no constraint or ndue influence. Brain L. pati • We, Andrea Holtzen and Sara Yelkin, the witnesses, sign our names to this instrument, being first duly sworn, and do hereby declare to the undersigned authority that the Owners signed and execute this transfer on death deed to transfer their interest in the described real property and they signed it willingly or either or both of them willingly directed another to sign for either or both of them, and that they executed it as their free and voluntary act for the purposes therein expressed, and that each of us, in the presence and hearing of the Owners, hereby signs this deed as witness to the Owners' signing, and that to the best of his or her knowledge the Owners are eighteen years of age or older or are not at this time minors and the Owners are of sound mind and under no constraint or undue influence. Andrea oltze STATE OF NEBRASKA ) ) ss. LANCASTER COUNTY ) 9.7 G7r r)-, 9ma1,4 6 -,tI E( L2 r f Wi ness Address `?355al," at 3z Dr ,cit„,trfi, AZ6 2S 7C2 Hess Address ACKNOWLEDGEMENT Subscribed, sworn to, and acknowledged before me by Gerain L. Spatz and Laura M. Spatz, the Owners, and subscribed and sworn to before me by, Andrea Holtzen and Sara Yelkin, witnesses, on June 20, 2023.