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CASH CHECK /(P 'CA ) Return to Galen E. Stehlik 724 W. Koenig Street Grand Island NE 68801 REFUNDS: CASH CHECK �R HALL r , Y NE IN3 7O7h 020 32 7O7b A it —3 P 2: 11 EEG1S Er. OF DEEDS TRANSFER ON DEATH DEED PURSUANT TO NEBRASKA UNIFORM REAL PROPERTY TRANSFER ON DEATH ACT I, Ignacio Romero, a single person, Grantor/Transferor, transfer all of my interest in the following described property to Pedro Javier Romero, if living, and if not then living to Oscar Romero, Yolanda Romero, and Juan Ignacio Romero. 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: Lot Twenty-two (22), Block Nine (9), Ashton Place, an Addition to the City of Grand Island, Hall County, Nebraska. I may revoke this deed. When recorded this deed revokes any Transfer on Death deed that I made before signing this "deed. � Executed: (I k(!wll , 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. WARNING: Property insurance on the transferred property may expire thirty days after the death of the transferor. Unless the transferor has added the designated beneficiary as an insured or additional named insured to the property insurance policy of the transferred property, any property insurance coverage of the transferred property will end on the earliest to occur of the following after the transferor's death: The end of the policy period as determined as if the transferor was still living; the date the designated beneficiary obtains alternative coverage; or thirty days after the transferor's death only if any premium required for the additional days beyond the policy period is paid.