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202501148 WARNING: The Department of Health and Human Services may require revocation of this deed by a transferor, a transferor's spouse, or both a transferor and the transferor's spouse in order to qualify or remain qualified for medicaid assistance. We, Gerald M. Koelzer and Lynette R. Koelzer, husband and wife, the transferors, sign our names to this instrument this 3 day of March, 2025, and being first duly sworn, do hereby declare to the undersigned authority that we sign and execute this transfer on death deed to transfer our interest in the described real property and that we sign it willingly or willingly direct another to sign for us, that we execute it as my free and voluntary act for the purposes therein expressed, that we are eighteen years of age or older or am not at this time a minor and that we are of sound mind and under no constraint or under influence. Gerald M. Koelzer, Transferor Lynette R. Koelzer, Transferor We, 1`� L(d Y (()' D and OSZeAtegek, the witnesses, sign our names to this instrument, being first duly sworn, anddo reby declare to the undersigned authority that the transferors sign and execute this transfer on death deed to transfer their interest in the described real property and that they sign it willingly or willingly directs another to sign for them, and they execute it as their free and voluntary act for the purposes therein expressed, and that each of us, in the presence and hearing of the transferors, hereby sign this deed as witness to the transferors' signing, and that to the best of their knowledge the transferors are eighteen years of age or older or are not at this time a minors and the transferors are of sound mind and under no constraint or undue influence. STATE OF NEBRASKA ss: COUNTY OF HALL Witness Subscribed, sworn to, and acknowledged before me by Gerald M. Koelzer and Lynette R. Koelzer, husbAnd And wife, the transferors, and subscribed and sworn to before me by 611 1 tt , l(CbL1 and Rrexd , witnesses, this 3 day of March, 2025. U GENERAL NOTARY - State of Nebraska GALEN STEHLIK My Comm. Exp. May 1, 2026