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CASH <br />CHEC <br />4 ERA <br />1I <br />RECORD AND RETURN TO: <br />Kevin A. Brostrom, #16208 <br />1811 West 2nd St., Suite 360 <br />Grand Island, NE 68803 <br />(308) 382-7810 <br />"7t (' I r <br />4 <br />REFUNDS: <br />CASH <br />CHECK <br />Nam.{..,r� �+` ED ��J; \' �i�ij <br />HALL C:1;J.J `'ITY NE <br />9 20(6 AFi 23 ? 2: 20 <br />t v'GLC) <br />REGISTER OF DEEDS <br />REVOCABLE TRANSFER ON DEATH DEED <br />NOTICE TO GRANTOR <br />tAd)°' <br />This form must be recorded with the Register of Deeds of the County in which the property is <br />located before your death and it also must be recorded with the Register of Deeds of the County <br />in which the property is located within 30 days after it was signed. If either of these requirements <br />is not met, this form will not be effective. <br />IDENTIFY INFORMATION ABOUT OWNER <br />Grantors making this deed: <br />Ronald D. Disney and Linda M. Disney Husband and Wife <br />As Joint Tenants with Rights of Survivorship <br />4201 Michigan Ave. <br />Grand Island, NE 68803 <br />NOTICE TO REGISTER OF DEEDS <br />This is a transfer on death deed and Form 521 is not required with the filing of this Transfer on <br />Death Deed under Neb. Rev. Stat. §76-214(2)(b). <br />LEGAL DESCRIPTION <br />The following real estate is transferred by this document, effective at the death of the second <br />Grantor to the Primary Beneficiary or to the Alternate Beneficiary as provided below: <br />Lot Ten (10), Block One (1), in Capital Heights Fourth Subdivision in the City of Grand <br />Island, Hall County, Nebraskal <br />PRIMARY BENEFICIARY <br />Grantors designate the following Primary Beneficiaries of this revocable transfer on death deed: <br />Tiffany R. Erlenbusch, 508 Elm St., St. Libory, NE 68872, and <br />Kevin A. Disney, 1220 South Jay St., Lakewood, CO 80232, <br />as Tenants in Common <br />TRANSFER ON DEATH <br />