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202305513 <br />Survivorship Required <br />Under Nebraska law, the interest of a designated beneficiary is contingent on the designated <br />beneficiary surviving the Transferors by one hundred twenty hours. <br />This TOD Deed is Revocable <br />Before our deaths, we have the right to revoke this deed. <br />Legally Required Warnings in the TOD Deed: <br />Please pay close attention to the following warnings. <br />Warning: <br />The property transferred remains subject to inheritance taxation in Nebraska to the same <br />extent as if owned by the transferor at death. Failure to timely pay inheritance taxes is <br />subject to interest and penalties as provided by law. <br />Warning: <br />The designated beneficiary is personally liable, to the extent of the value of the property <br />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 <br />designated beneficiary may also be personally liable, to the extent of the value of the <br />property transferred, for claims against the estate, statutory allowances to the transferor's <br />surviving spouse and children, and the expenses of administration to the extent needed to <br />pay such amounts by the personal representative. <br />Warning: <br />The Department of Health and Human Services may require revocation of this deed by a <br />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 />Signature of Owners Making This Transfer on Death Deed <br />We, Darcy D. Moul and Darcy E. Moul, the transferors, sign our names to this instrument on <br />OLfo►,er 9 , 2023, and being first duly sworn, do hereby declare to the undersigned <br />authority that we sign and execute this transfer on death deed to transfer our interest in the <br />described real property and that we sign it willingly or willingly direct another to sign for us, that <br />we execute it as our free and voluntary act for the purposes therein expressed, that we are <br />eighteen years of age or older or are not at this time minors, and that we are of sound mind and <br />under no constraint or undue influence. <br />Darcy D.ul, Transferor <br />Darcy E. oul, Transferor <br />Warning: The two witnesses must be disinterested for this Deed to be valid. An interested <br />witness means any individual who, on the date of this deed, is or would be entitled to receive <br />any interest in the land under this transfer on death deed if the transferors died under the <br />circumstances existing at the date of the signing of this deed, or any child, spouse, or heir of <br />that person. <br />We, (-rte-\_ rl .e and k e b c, �o� w+� , the <br />witnesses, sign our names to this instrument, being first duly sworn, and do hereby declare to the <br />undersigned authority that the transferors sign and execute this transfer on death deed to transfer <br />their interest in the described real property and that they sign it willingly or willingly direct <br />another to sign for them, and that they execute it as their free and voluntary act for the purposes <br />therein expressed, and that each of us, in the presence and hearing of the transferors, hereby <br />signs this deed as witness to the transferors' signing, and that to the best of his or her knowledge <br />the transferors are eighteen years of age or older or are not at this time minors and the transferors <br />are of sound mind and under no constraint or undue influence. <br />Page 2 of 3 <br />