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099£0£Z0Z <br />1/4 <br />etum to <br />Galen E. Stehlik <br />P O Box 400 <br />Grand Island NE 68802 <br />CASH <br />CHECK /(D ,G(j <br />REFUNDS: <br />CASH <br />CHECK - <br />HA! <br />pw <br />MST Z523 03b50 2023 5! <br />TRANSFER ON DEATH DEED <br />PURSUANT TO NEBRASKA UNIFORM REAL PROPERTY TRANSFER ON <br />DEATH ACT <br />I, Kenneth W. Ruff, a single person, Grantor/Transferor, transfer all of my interest in the <br />following described property to Troy D. Ruff, a single person, and Gerri L. Jackson, a single <br />person. Said transfer to be effective at my death. The real estate (as defined in Neb. Rev. Stat. <br />§76-201) in Hall County, Nebraska is described as follows: <br />Lot Seven (7), Block Fifteen (15), in the original town, now City of Grand Island, Hall <br />County, Nebraska. <br />I may revoke this deed. When recorded this deed revokes any Transfer on Death deed that <br />I made before signing this deed. <br />Executed: July 11 , 2023. <br />WARNING: 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 subject <br />to interest and penalties as provided by law. <br />WARNING: 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, for <br />claims against the estate, statutory allowances to the transferor's surviving spouse and children, <br />and the expenses of administration to the extent needed to pay such amounts by the personal <br />representative. <br />WARNING: The Department of Health and Human Services may require revocation of this deed <br />by 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 />I, Kenneth W. Ruff, a single person, the transferor, sign my name to this instrument this <br />day of July, 2023, and being first duly sworn, do hereby declare to the undersigned <br />authority that I sign and execute this transfer on death deed to transfer my interest in the described <br />real property and that I sign it willingly or willingly direct another to sign for me, that I execute it <br />as my free and voluntary act for the purposes therein expressed, that I am eighteen years of age or <br />older or am not at this time a minor and that I am of sound mind and under no constraint or under <br />influence. <br />w <br />i ):4IV <br />Kenneth . uff, Transferor <br />