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202500047 <br />Primary Beneficiaries <br />I designate the following Primary Beneficiary of this Revocable Transfer on Death Deed so long <br />as such Primary Beneficiaries survives me. <br />Names of Primary Beneficiary: Mailing Addresses of Primary Beneficiary: <br />Megan A. Hatheway 918 Regency Pkwy #101, Omaha, Nebraska <br />68114 <br />Alternate Beneficiary <br />If all my Primary Beneficiaries do not survive me, I designate the following Alternate Beneficiary <br />if such Alternate Beneficiary me: NONE. <br />Transfer on Death <br />At my death, I transfer my interest in the described real property to the beneficiaries as designated <br />above. The transfer occurs at the death of the Owner/Transferor. <br />Survivorship Required <br />Under Nebraska law, the interest of a designated beneficiary is contingent on the designated <br />beneficiary surviving the Owner/Transferor by one hundred twenty (120) hours. <br />The Transfer on Death Deed is Revocable <br />Before my death, I have the right to revoke this deed. <br />Growing Crops <br />If this real property is agricultural land, the growing crops shall pass to: <br />The Primary or Alternate Beneficiary <br />The estate of the survivor of us <br />I understand that if I indicate no choice above, such growing crops will pass to my estate. <br />Legally Required Warnings in the Transfer on Death Deed: Please pay close attention to the <br />following warnings: <br />Warning: The real property transferred remains subject to inheritance taxation in <br />Nebraska to the same extent as if owned by the Owner/Transferor at death. Failure <br />to timely pay inheritance taxes is subject to interest and penalties as provided by <br />law. <br />Warning: The designated beneficiaries are personally liable, to the extent of the <br />value of the real property transferred, to account for Medicaid reimbursement to the <br />extent necessary to discharge any such claim remaining after application of the <br />assets of the Owner's/Transferor's estate. The designated beneficiaries may also <br />be personally liable, to the extent of the value of the real property transferred, for <br />Revocable Transfer on Death Deed <br />Page 2 <br />