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202502015 <br />Warning: <br />The property transferred remains subject to inheritance taxation in Nebraska to the same <br />extent as if owned by the transferor at death. Failure to timely pay inheritance taxes is <br />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 property <br />transferred, to account for Medicaid reimbursement to the extent necessary to discharge <br />any such claim remaining after application of the assets of the last surviving transferor's <br />estate. The designated beneficiary may also be personally liable, to the extent of the value <br />of the property transferred, for claims against the estate, statutory allowances to the last - <br />surviving transferor's surviving spouse and children, and the expenses of administration to <br />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 <br />transferor, a transferor's spouse, or both a transferor and the transferor's spouse in order to <br />qualify or remain qualified for Medicaid assistance. <br />Signature of Owners Making This Transfer on Death Deed <br />We, Frank J. Martinez and Donita E. Martinez, the transferors, sign our names to this instrument <br />on 4—`v --- 2 j , 2025, and being first duly sworn, do hereby declare to the undersigned <br />authority that we sign and execute this transfer on death deed to transfer our interest in the <br />described real property and that we sign it willingly or that one or both of us willingly direct <br />another to sign for that signer or signers, that we execute it as our free and voluntary act for the <br />purposes therein expressed, that we are eighteen years of age or older or are not at this time a <br />minor, and that We are of sound mind and under no constraint or undue influence. <br />Frank J. Martinez, Transfer <br />dO6YlJJ <br />Donita E. Martinez, Transferor <br />Warning: The two witnesses must be disinterested for this Deed to be valid. An interested <br />witness means any individual who on the date that this deed is or would be entitled to receive <br />any interest in the land under this transfer on death deed if the transferor died under the <br />circumstances existing at the date of the signing of this deed or any child, spouse or heir of that <br />person. <br />We, Nord, Sci'1co 11 and Ai / <br />�dor1 , the <br />witnesses, sign our names to this instrument, being first duly sworn, an hereby declare to the <br />undersigned authority that the transferors sign and execute this transfer on death deed to transfer <br />their interest in the described real property and they sign it willingly or either or both of them <br />willingly directs another to sign for either or both of them, and that they execute it as their free and <br />Transfer on Death Deed - Page No. 3 <br />