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202401369 Transfer on Death At my death, I transfer my interest in the described property to the beneficiaries as designated above. The transfer occurs at the death of the Transferor. Survivorship Required Under Nebraska Law, the interests of the designated beneficiaries is contingent on the designated beneficiaries or alternate beneficiaries surviving me, the transferor by one hundred twenty hours. This TOD Deed is revocable Before my death, I have the right to revoke this deed. Legally Please pay close attention to the following warnings: Warning: The property transferred remains subject to inheritance taxation in Nebraska to the same extent as if owned by the transferor at death. Failure to timely pay inheritance taxes is subject to interest and penalties as provided by law. Warning: The designated beneficiaries are 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 transferor's estate. The designated beneficiaries may also be personally liable, to the extent of the value of the property transferred, for claims against the estate, statutory allowances to the transferor's surviving spouse and children, and the expense 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 transferor, a transferor's spouse, or both a transferor and transferor's spouse in order to qualify or remain qualified for Medicaid assistance. Signature of Owner Making this Transfer on Death Deed I, Clayton LeRoy Green, the transferor, sign my name to this instrument on (p , 2024, 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 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 and am not at this time a minor, and that I am of sound mind and under no constraint or undue influence.