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IMINSEINIMIMMIME pilin w RECORDED sts w HALL COUNTY NE co 1NST 1013 0 5 3 1 8 Z023 OCT 10 A 10: 53 CASH � CHECr. " REFUNDS: CASH CHECK KI ISTI WOLD REGISTER OF DEEDS Retum to Wroblewski & Gawrych Law Office LLC {Space above this line for Recording Stamps) Preparer: P.O. Box 23, St. Paul, NE 68873-0023 REVOCABLE TRANSFER ON DEATH DEED (Single Owner) Notice to Owner You should each carefully read all information on this form. You May Want to Consult a Lawyer before Using This Form. 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. Identifying Information about Owner Name Mailing Address Ricky C. Davison 624 E Bismark Road, Grand Island, NE 68801 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 Owner to the Primary Beneficiary or to the Alternate Beneficiary as provided below. Lot One (1) in Spelts-Schultz Addition to the City of Grand Island, Hall County, Nebraska, according to the recorded plat thereof. Primary Beneficiary 1 designate the following Primary Beneficiary of this Revocable Transfer on Death Deed if the Primary Beneficiary survives me: 1/3 interest to Tracy Hanger, 2325 NW 43rd Street, Lincoln, NE 68528 1/3 interest to Mindy Davison, 3170 Casa de Campo, Apt 4, San Mateo, CA 94403-2181 1/3 interest to Jessica Davison -Moan, 1925 Chemeketa St. NE, Salem, OR 97301