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CASH CHECK !Co 00 N CO w� Return to Mary J. Livingston P O Box 1563 Grand Island NE 68802 INST t7b 0 0 3 9 REFUNDS: CASH CHECK RE.C1) ED HALL COUNTY NTY NE 1016 FE5 2 P 2: 50 KkISii'\`,'OLD REGISTER OF DEEDS TRANSFER ON DEATH DEED PURSUANT TO NEBRASKA UNIFORM REAL PROPERTY TRANSFER ON DEATH ACT I, James H. O'Brien, a single person, Grantor/Transferor, transfer all of my interest in the following described property to Tonia M. Luschei. Said transfer to be effective at my death. The real estate (as defined in Neb. Rev. Stat. '76-201) in Hall County, Nebraska is described as follows: The North 9 Feet of Lot 3 and the South 46 Feet of Lot 1, Block 22, Scarff's Addition to West Lawn, City of Grand Island, Hall County, Nebraska. Also known as 1614 N. Kruse Ave., Grand Island, Nebraska. I may revoke this deed. When recorded, this deed revokes any Transfer on Death deed that I made before signing this deed. Executed: FE,B . I I , 2026. WARNING: The property transferred remains subject to inheritance taxation in Nebraska to the same extent as if owned by the transferor at death. Failure to timely pay inheritance taxes is subject to interest and penalties as provided by law. WARNING: The designated beneficiary is personally liable, to the extent of the value of the property transferred, to account for medicaid reimbursement to the extent necessary to discharge any such claim remaining after application of the assets of the transferor's estate. The designated beneficiary may also be personally liable, to the extent of the value of the property transferred, for claims against the estate, statutory allowances to the transferor's surviving spouse and children, and the expenses of administration to the extent needed to pay such amounts by the personal representative. 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. I, James H. O'Brien, a single person, the transferor, sign my name to this instrument this 111) day of �� , 2026, and being first duly sworn, do hereby declare to the undersigned authority that I sign and execute this transfer on death deed to transfer my interest in the described real property and that I sign it willingly or willingly direct another to sign for me, that I execute it as my free and voluntary act for the purposes therein expressed, that I am eighteen years of age or older or am not at this time a minor and that I am of sound mind and under no constraint or under influence. ames H. O'Brien, Transferor