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202405796 <br />Survivorship Required: <br />Under Nebraska law, the interest of a designated beneficiary is contingent on <br />the designated beneficiary surviving the transferor by one hundred twenty <br />hours. <br />This TOD Deed is Revocable: <br />Before my death, I have the right to revoke this Deed. <br />Warning: <br />The property transferred remains subject to inheritance taxation in Nebraska <br />to the same extent as if owned by the transferor at death. Failure to timely pay <br />inheritance taxes is 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 <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 />2 <br />