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CASH CHEC REFUNDS: CASH RR .CC, D[ D HALL C r".QTY NE INST 2024 0 19 b I 2024 HAY - P 12: 59 i=�cr.l, ULD REGISTER OF DEEDS Return to: Kevin P. Walsh Smith Johnson Law Firm 104 N. Wheeler Avenue Grand Island, NE 68801 REVOCABLE TRANSFER ON DEATH DEED Notice to Owner You should carefully read all information on this form. This transfer on death deed must be recorded with the Register of Deeds of the County in which the property is located, before your death and within 30 days after being signed. If either of these requirements is not met, this transfer on death deed will not be effective. Identifying Information about Owners Name of Owners Mailing Address of Owners Kiffani L. Smith 40005 Heritage Hollow, Lot 1 Georgetown, TX 78626 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 deaths of the Owner, to the Beneficiary as provided below: See Exhibit "A" Beneficiary I designate the following beneficiary of this revocable transfer on death deed if the beneficiary survives me: Name of Beneficiary Jaydn Alexander Smith Mailing Address of Beneficiary 528 Copper Lane Jarrell, TX 76537 Transfer on Death At my death, I transfer my interest in the described property to the beneficiary as designated above. The transfer occurs at the death of the Transferor. Survivorship Required Under Nebraska law, the interest of a designated beneficiary is contingent on the designated beneficiary surviving the Transferor by one hundred twenty hours. This TOD Deed is Revocable Before my death, l have the right to revoke this deed. Page 1 of 4