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202403816 <br />Primary Beneficiaries: <br />I designate the following beneficiary of this revocable transfer on death deed if the beneficiary <br />survives me. <br />Name of Primary Beneficiary <br />CYNTHIA M. MILLER <br />PAUL D. BOROWIAK <br />CHERYL ANN PICKEREL <br />Mailing Address of Primary Beneficiary <br />513 SHANNON DR. <br />NORFOLK, NE 68701 <br />53685 S. 360TH AVE. <br />SILVER CREEK, NE 68663 <br />725 MIDDLETON AVE. <br />LINCOLN, NE 68521 <br />BRIDGETTE L. MCCAUL 67-320 KAIEA PLACE <br />WAIALUA, HI 96791 <br />Transfer on Death <br />At my death, I transfer my interest in the described property to the beneficiary as designed above. <br />The transfer occurs at the death of the Transferor. <br />Survivorship Required <br />Under Nebraska law, the interest of a designed beneficiary is contingent on the designated <br />beneficiary surviving the transferor by one hundred twenty hours. <br />This TOD Deed is Revocable <br />Before my death, I have the right to revoke this deed. <br />Required Warnings in the TOD Deed: <br />Please pay close attention to the following warnings. <br />Warning: <br />The property transferred remains subject to inheritance taxation in Nebraska to the same <br />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: <br />The designed beneficiary is personally liable, to the extent of the value of the property <br />transferred, to account for Medicaid reimbursement to the extent necessary to discharge any <br />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 <br />transferred, for claims against the estate, statutory allowances to the transferor's surviving <br />spouse and children, and the expenses of administration to the extent needed to pay such <br />amounts by the personal representative. <br />Page 2 of 4 <br />