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202404441 <br />The designated beneficiary is personally liable, to the extent of the value of the <br />property transferred, to account for Medicaid reimbursement to the extent <br />necessary to discharge any such claim remaining after application of the assets <br />of the transferor's estate. The designated beneficiary may also be personally <br />liable, to the extent of the value of the property transferred, for claims against <br />the estate, statutory allowances to the transferor's surviving spouse and <br />children, and the expenses of administration to the extent needed to pay such <br />amounts by the personal representative. <br />Warning: <br />The Department of Health and Human Services may require revocation of this <br />Deed by a transferor, a transferor's spouse, or both a transferor and the <br />transferor's spouse in order to qualify or remain qualified for Medicaid <br />assistance. <br />Signature of Owner Making this Transfer on Death Deed: <br />I, Magdaline A. Randolph, the transferor, sign my name to this instrument on <br />September (6 2024, and being first duly sworn, do hereby declare to the <br />undersigned authority that I sign and execute this Transfer on Death Deed to <br />transfer my interest in the described real property and that I sign it willingly; <br />that I execute it as my free and voluntary act for the purposes therein, that I <br />am 18 years of age or older and that I am of sound mind and under no <br />constraint or undue influence. <br />94f <br />Ze-/^4 <br />MAGDACINE A. RANDOLPH, Transferor <br />3 <br />