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202402376
<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, Katherine Marie Hilling and Haydn Ho and Hilling Jr., wife and husband, the transferors, sign our
<br />names to this instrument on 6 .99. a , 2024, and being first duly sworn, do hereby declare to
<br />the undersigned 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 that one or both of us willingly direct another to sign
<br />for that signer or signers, that we execute it as our free and voluntary act for the purposes therein expressed,
<br />that we are eighteen years of age or older or are not at this time a minor, and that We are of sound mind and
<br />unde noconstraint or undue ' uence.
<br />aCkit,g -1)
<br />Katherine Marie Hilling, Transferor Haydn oward Hilling Jr., Transferor
<br />Warning: The two witnesses must be disinterested for this Deed to be valid. An interested witness means
<br />any individual who on the date that this deed is or would be entitled to receive any interest in the land
<br />under this transfer on death deed if the transferor died under the circumstances existing at the date of the
<br />signing of this deed or any child, spouse or heir of that person.
<br />We, I4OlNDA.Sa.%Po /1
<br />and 6i, ,4 x/9► $4,t , the witnesses, sign
<br />our names to this instrument, being first duly sworn, and do hereb declare to the undersigned authority
<br />that the transferors sign and execute this transfer on death deed to transfer their interest in the described real
<br />property and they sign it willingly or either or both of them willingly directs another to sign for either or
<br />both of them, and that they execute it as their free and voluntary act for the purposes therein expressed, and
<br />that each of us, in the presence and hearing of the transferors, hereby signs this deed as witness to the
<br />transferors' signing, and that to the best of his or her knowledge the transferors are eighteen years of age or
<br />older or are not at this time minors and the transferors are of sound mind and under no constraint or undue
<br />influence.
<br />('tCTJCtfLU,QJ308 N. Locust, Ste. 501, Grand Island, NE 68801
<br />W ness' Name Witness' Address
<br />308 N. Locust, Ste. 501, Grand Island, NE 68801
<br />Witness' Name ' Witness' Address
<br />Acknowledgement
<br />STATE OF NEBRASKA, COUNTY OF HALL, SS:
<br />Subscribed, sworn to, and acknowledged before me by Katherine Marie Hilling and by Haydn Howard
<br />Hilling Jr., the transferors, and subscribed and sworn to before me by /[7Y‘12., Sc 1102 \.)
<br />and
<br />[Seal]
<br />L41' A 211
<br />, witnesses, on c5 ,- a 1 , 2024.
<br />GENERAL Nebras4 4041
<br />ZACHARY BUTZMy Comm. Exp. May 16, 2025M , 11161?
<br />Transfer on Death Deed - Page No. 3
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