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CASH CHECK 0,7‘,9 ..1'► REFUNDS: CASH CHECK s, RECORDED Iv HALL COUNTY NE 0�'��OI3SEPZJ A�O� � � MST 1013 0 S 0 $ 8 KRISTI WOLD REGISTER OF DEEDS RECORD AND RETURN TO: Kevin A. Brostrom, #16208 / 1811 West 2nd St., Suite 360 Grand Island, NE 68803 (308) 382-7810 REVOCABLE TRANSER ON DEATH DEED NOTICE TO GRANTOR 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. IDENTIFY INFORMATION ABOUT OWNER Grantor making this deed: Doris L. Sass, an unremarried widow 1911 West 11th St. Grand Island, NE 68803 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 Grantor to the Primary Beneficiary: Lots Two (2) and Three (3), Block Eleven (11), in Boggs and Hill's Addition, an Addition to the City of Grand Island, Hall County, Nebraska. PRIMARY BENEFICIARY Grantor designates the following Primary Beneficiary of this revocable transfer on death deed: Douglas W. Sass, 2915 Hancock Place, Grand Island, NE 68803 and Daniel C. Sass, 14710 Ernst, Bennington, NE 68007, as Tenants in Common. TRANSFER ON DEATH At the Grantor's death, Grantor transfers Grantor's interest in the described property to the Primary Beneficiary as designated above. The transfer occurs at the death of the Grantor.