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a <br />CO <br />V Return to <br />Galen E. Stehlik <br />P O Box 400 <br />Grand Island NE 68802 <br />CASH <br />CHECK <br />REFUNDS: <br />CASH <br />CHECK <br />RECORDED <br />HALL COUNTY NE <br />INST 2O2U 0 '1 1 1 9 Ell MAR 18 A 10: Lib <br />KRISTi WOLD <br />REGISTER OF DEEDS <br />TRANSFER ON DEATH DEED <br />PURSUANT TO NEBRASKA UNIFORM REAL PROPERTY TRANSFER ON <br />DEATH ACT <br />I, Larry Gibreal, a single person, Grantor/Transferor, transfer all of my interest in the <br />following described property to Alan G. Gibreal and Mathew C. Gibreal. Said transfer to be <br />effective at my death. The real estate (as defined in Neb. Rev. Stat. §76-201) in Hall County, <br />Nebraska is described as follows: <br />Lot 3, Block 9, Wallichs Addition to the City of Grand Island, Hall 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: March (3 , 2024. <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 <br />subject 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, <br />for claims against the estate, statutory allowances to the transferor's surviving spouse and <br />children, and the expenses of administration to the extent needed to pay such amounts by the <br />personal 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, Larry Gibreal, a single person, the transferor, sign my name to this instrument this <br />(?j day of March, 2024, 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 />Larry Taal, Transferor <br />