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CASH <br />CHECK (12.O() <br />REFUNDS: <br />iv CASH <br />41. _- CK <br />es <br />_ HALL C . NT Y NE <br />03 <br />0) <br />INET 2021 0 1 s b 6 <br />Return to <br />Mary J. Livingston �✓ <br />P O Box 1563 <br />Grand Island NE 68802 <br />20211 APB }i( P 1:01 <br />Kf'ZISTI \'''FOLD <br />REGISTER OF DEEDS <br />TRANSFER ON DEATH DEED <br />PURSUANT TO NEBRASKA UNIFORM REAL PROPERTY TRANSFER ON <br />DEATH ACT <br />I, Sandra L. Rodewald, a single person, Grantor/Transferor, transfer all of my interest in <br />the following described property to Kelly D. Rodewald and Kyle D. Rodewald, as joint tenants. <br />Said transfer to be effective at my death. The real estate (as defined in Neb. Rev. Stat. '76-201) <br />in Hall County, Nebraska is described as follows: <br />Lot Thirty (30), in West Lawn, in the City of Grand Island, Hall County, Nebraska. <br />Also known as 1811 Grand Island Avenue, Grand Island, Nebraska. <br />I may revoke this deed. When recorded, this deed revokes any Transfer on Death deed <br />that I made before signing this deed. <br />Executed: April , 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, Sandra L. Rodewald, a single person, the transferor, sign my name to this instrument <br />this elle day of April, 2024, and being first duly sworn, do hereby declare to the <br />undersigned authority that I sign and execute this transfer on death deed to transfer my interest in <br />the described real property and that I sign it willingly or willingly direct another to sign for me, <br />that I execute it as my free and voluntary act for the purposes therein expressed, that I am <br />eighteen years of age or older or am not at this time a minor and that I am of sound mind and <br />under no constraint or under influence. <br />).c4,,,,40k41/4_J perafLuredj <br />Sandra L. Rodewald, Transferor <br />