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202404021 <br />Primary Beneficiaries: <br />I designate the following beneficiaries of this revocable transfer on death deed if the beneficiaries <br />survive me. <br />Name of Primary Beneficiary Mailing Address of Primary Beneficiary <br />VILLA SCOTTI <br />SOUKS BOUTMAHAVONG <br />JAKE BOUTMAHAVONG <br />15180 BRAINBRIDGE CIR. <br />PORT CHARLOTTE, FL 33981 <br />1801 W. BIG SKY RD. <br />LINCOLN, NE 68521 <br />195 LIZZETH DR. <br />HOLLAND, MI 49423 <br />Transfer on Death <br />At my death, I transfer my interest in the described property to the beneficiaries as designated <br />above. The transfer occurs at the death of the Transferor. <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 />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 designated 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 <br />any such claim remaining after application of the assets of the transferor's estate. The <br />designated beneficiary may also be personally liable, to the extent of the value of the <br />property transferred, for claims against the estate, statutory allowances to the transferor's <br />surviving spouse and children, and the expenses of administration to the extent needed to <br />pay such amounts by the personal representative. <br />Warning: <br />Transfer on Death Deed - Page No. 2 <br />