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202403731 <br />SURVIVORSHIP REQUIRED <br />Under Nebraska law, the interest of a designated beneficiary is contingent on the designated <br />beneficiary surviving the transferor by one hundred twenty hours. <br />TRANSFER ON *:)EATH DEED REVOCABLE <br />Before Grantors' d ath, Grantors have the right to revoke this deed. <br />LEGALLY REQ IRED WARNINGS <br />WARNINI <br />to the sam <br />taxes is sul <br />WARNING <br />the propert; <br />discharge a <br />The design <br />property tri <br />surviving s <br />pay such at <br />WARNIN 1 <br />this deed b <br />order to qu <br />SIGNATURE 0 <br />We, Richard F. Fo <br />instrument this <br />undersigned autho <br />in the described re <br />us, that we execut: <br />eighteen years of <br />under no constrain <br />: The property transferred remains subject to inheritance taxation in Nebraska <br />extent as if owned by the Grantor at death. Failure to timely pay inheritance <br />ect to interest and penalties as provided by law. <br />: The designated Beneficiary is personally liable, to the extent of the value of <br />transferred, to account for Medicaid reimbursement to the extent necessary to <br />iy such claim remaining after application of the assets of the Grantor's estate. <br />ted Beneficiary may also be personally liable, to the extent of the value of the <br />nsferred, for claims against the estate, statutory allowances to the Grantor's <br />souse and children, and the expenses of administration to the extent needed to <br />counts by the personal representative. <br />: The Department of Health and Human Services may require revocation of <br />a Grantor, a Grantor's spouse, or both a Grantor and the Grantor's spouse in <br />lify or remain qualified for Medicaid assistance. <br />OWNER MAKING THIS TRANSFER ON DEATH DEED <br />and Marilyn S. Fox, Husband and Wife, the Grantors, sign our names to this <br />day of July, 2024 and being first duly sworn, do hereby declare to the <br />ty that we sign and execute this transfer on death deed to transfer our interest <br />1 property and that we sign it willingly or willingly direct another to sign for <br />it as our free and voluntary acts for the purposes therein expressed, that we are <br />ge or older or are not at this time minors, and th,. we ; - ofund mi <br />or undue influence. <br />MARILYN S. FOX, Grantor <br />