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202501921 <br />Legally Required Warning in the TOD Deed: <br />Please pay close attention to the following warnings: <br />Warning: <br />The property transferred remains subject to inheritance taxation in Nebraska to the same extent as <br />if owned by the transferor at death. Failure to timely pay inheritance taxes is subject to interest and <br />penalties as provided by law. <br />Warning: <br />The designated beneficiary is personally liable, to the extent of the value of the property transferred, <br />to account for Medicaid reimbursement to the extent necessary to discharge any such claim remaining <br />after application of the assets of the last surviving transferor's estate. The designated beneficiary may <br />also be personally liable, to the extent of the value of the property transferred, for claims against the <br />estate statutory allowances to the last surviving transferor's surviving spouse and children, and the <br />expenses of administration to the extent needed to pay such amounts by the personal representative. <br />Warning: <br />The Department of Health and Human Services may require revocation of this deed by a transferor, a <br />transferor's spouse, or both a transferor and the transferor's spouse in order to qualify or remain <br />qualified for Medicaid assistance. <br />Signature of Owner Making This Transfer on Death Deed: <br />We, LARRY L. JERATOWSKI and TRUDY K. JERATOWSKI, the transferor(s), sign our names to this <br />instrument on March 31, 2025, and being first duly sworn, do hereby declare to the undersigned authority that <br />we sign and execute this transfer on death deed to transfer our interest in the described real property and that <br />we sign it willingly or that one or both of us willingly direct another to sign for that signer or signers, that we <br />execute it as our free and voluntary act for the purposes therein - .ressed, that we are eighteen years of age of <br />older or are not at this time a minor, and that we are of sound ►► .. nd under no nt or u A ue influ <br />Y L. J '4 ' Sirrrantor <br />TRUDY K. RA <br />SKI, Grantor <br />Warning: <br />The two witnesses must be disinterested for this Deed to be valid. Interested witness means any individual <br />who on the date that this deed is executed is or would be entitled to receive any interest in the land if the <br />transferor died under the circumstances existing at the date of the signing of this deed . <br />We, Carissa D. Mobley, and j)tU 4 m. CO)V, the witnesses, sign our names to this instrument, being first <br />duly sworn, and do hereby declare to the undersigned authority that the transferor signs and executes this <br />transfer on death deed to transfer his or her interest in the described real property and he or she signs it <br />willingly or willingly directs another to sign for him or her, and that he or she executes it as their free and <br />voluntary act for the purposes therein expressed, and the each of us, in the presence and hearing of the <br />transferor, hereby signs this deed as a witness to the transferor's signing , and that to the best of our knowledge <br />the transferor is eighteen years of age or older or is not at this time a minor and the transferor is of sound mind <br />and under no constraint or undue influence. <br />01/14/ --Ceae/w <br />Carissa D. Mobley, Witness • .�, irr� , Witness <br />159 N. Wolcott St., Ste. 400 159 N. Wolcott St., Ste. 400 <br />Casper, Wyoming 82601 Casper, Wyoming 82601 <br />2 <br />