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CASH <br />CHECK 2539° <br />REFUNDS: <br />CASH <br />_ CHECK <br />RECORD <br />HALLHALL(.21,,'..!-Pc NE <br />IST 7023 0 3 3 5 3 2.023 v=.:'_ 1: 1414 <br />2g o0 <br />Return to: <br />John B. McDermott <br />308 N. Locust Ste 501 <br />Grand Island, NE 68801 <br />REVOCABLE TRANSFER ON DEATH DEED <br />Notice to Owner <br />You should carefully read all information on this form. You May Want to Consult a Lawyer before <br />Using This Form. <br />This form must be recorded with the Register of Deeds of the County in which the property is <br />located before your death and it also must be recorded with the Register of Deeds of the County in <br />which the property is located within 30 days after it was signed. If either of these requirements is <br />not met, this form will not be effective. <br />Identifying Information about Owner(s) <br />Name of Owner <br />JACK W. RYSAVY <br />124 N. ARAPAHOE, 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 death of the Owner to the <br />Primary Beneficiary or to the Alternate Beneficiary as provided below. <br />LOT SIX (6), IN BLOCK ONE (1), DALE ROUSH SUBDIVISION, IN HALL <br />COUNTY, NEBRASKA <br />Page 1 of 4 <br />