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202602816 <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 />Warning: <br />Property insurance on the transferred property may expire thirty days after the death of the <br />transferor. Unless the transferor has added the designated beneficiary as an insured or <br />additional named insured to the property insurance policy of the transferred property, any <br />property insurance coverage of the transferred property will end on the earliest to occur of <br />the following after the transferor's death: The end of the policy period as determined as if <br />the transferor was still living; the date the designated beneficiary obtains alternative <br />coverage; or thirty days after the transferor's death only if any premium required for the <br />additional days beyond the policy period is paid. <br />Signature of Owners Making This Transfer on Death Deed <br />We, William J. Evans and Beatrice K. Evans, the transferors, sign our names to this instrument <br />on S - , 2026, 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 />William J..E ans, Transferor <br />Beatrice K. Evans, 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, yeSSeniA Garda-(Ylorictezand "ail / irr /7 , the <br />witnesses,sign our names to this instrument,beingfirst dulysworn do herebydeclare to the <br />� <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 />voluntary act for the purposes therein expressed, and that each of us, in the presence and hearing <br />Transfer on Death Deed - Page No. 3 <br />