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202305018 SURVIVORSHIP REQUIRED Under Nebraska law, the interest of a designated beneficiary is contingent on the designated beneficiary surviving the transferor by one hundred twenty hours. TRANSFER ON DEATH DEED REVOCABLE Before Grantor's death, Grantor has the right to revoke this deed. LEGALLY REQUIRED WARNINGS WARNING: The property transferred remains subject to inheritance taxation in Nebraska to the same extent as if owned by the Grantor at death. Failure to timely pay inheritance taxes is subject to interest and penalties as provided by law. WARNING: The designated Beneficiary is personally liable, to the extent of the value of the property transferred, to account for Medicaid reimbursement to the extent necessary to discharge any such claim remaining after application of the assets of the Grantor's estate. The designated Beneficiary may also be personally liable, to the extent of the value of the property transferred, for claims against the estate, statutory allowances to the Grantor's surviving spouse and children, and the expenses of administration to the extent needed to pay such amounts by the personal representative. WARNING: The Department of Health and Human Services may require revocation of this deed by a Grantor, a Grantor's spouse, or both a Grantor and the Grantor's spouse in order to qualify or remain qualified for Medicaid assistance. SIGNATURE OF OWNER MAKING THIS TRANSFER ON DEATH DEED rat I, Doris L. Sass, an unremarried widow, the Grantor, sign my name to this instrument this / 9 day of September, 2023 and being first duly sworn, do hereby declare to the undersigned authority that I sign and execute this transfer on death deed to transfer my interest in the described real property and that I sign it willingly or willingly direct another to sign for me, that I execute it as my free and voluntary act for the purposes therein expressed, that I am eighteen years of age or older or are not at this time a minor, and that I am of sound mind and under no constraint or undue influence. fir'"° o�-• `�� DORIS L. SASS, Grantor DECLA TION OF ITNESSES g/6941 We, 7' �i(77'("1—jJ�— and /� //�Q�/ the witnesses, sign our names to this instrument, being first duly sworn, and do hereby declare to the undersigned authority that the Grantor signs and executes this transfer on death deed to transfer Grantor's interest in the described real property and that Grantor signs it willingly or willingly directs another to sign for Grantor, and that Grantor executes it as her free and voluntary act for the purposes therein express, and that each of us, in the presence and hearing of the Grantor hereby signs this deed as witness to the Grantor's signing, and that to the best of the undersigned's knowledge the Grantor is eighteen years or age or older or is not at this time a minor and the Grantor is of sound mind and under no constraint or undue influe e.