202405383 - Laserfiche WebLink

Browse

202405383 Warning: The designated beneficiary is personally liable, to the extent of the value of the real property transferred, to account for Medicaid reimbursement to the extent necessary to discharge any such claim remaining after application of the assets of the Owner's/Transferor's estate. The designated beneficiary may also be personally liable, to the extent of the value of the real property transferred, for claims against the estate, statutory allowances to the Owner's/Transferor's surviving spouse and children, and the expenses of administration to the extent needed to pay such amounts by the personal representative. Warning: The Department of Health and Human Services may require revocation of this deed by an Owner/Transferor, an Owner's/Transferor's spouse, or both an Owner/Transferor and the Owner's/Transferor's spouse in order to qualify or remain qualified for Medicaid assistance. I, LaVonne K. Kulus, the Owner/Transferor, sign my name to this instrument on the date of 4-0 be r ?�v 2ej. 4 and being first duly sworn, do hereby declare to the undersigned authority that I sign and execute this Revocable Transfer on Death Deed to transfer my interest in the described real property and that I sign it willingly or willingly direct another to sign for me, that I execute it as my free and voluntary act for the purposes therein expressed, that I am eighteen years of age or older or am not at this time a minor, and that I am of sound mind and under no constraint or undue influence. LaVonne K. Kulus, Owner/Transferor Warning: The two witnesses must be disinterested for this deed to be valid. An interested witness means any individual who on the date that this deed is executed is or would be entitled to receive any interest in the real property if the Owner/Transferor died under the circumstances existing at the date of the signing of this deed. We, fL / WI cZ and C` r.,,_ \\e n rtckU L the witnesses, sign our nam s to this instrument, being first duly sworn, and do hereby declare to the undersigned authority that the Owner/Transferor signs and executes this Revocable Transfer on Death Deed to transfer his or her interest in the described real property and he or she signs it willingly or willingly directs another to sign for him or her, and that he or she executes it as his or her free and voluntary act for the purposes therein expressed, and that each of us, in the presence and hearing of the Owner/Transferor, hereby signs this deed as witness to the Owner's/Transferor's signing, and that to the best of his or her knowledge the Owner/Transferor is eighteen years of age or