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202603408 Name of Primary Beneficiary Mailing Address of Primary Beneficiary TONI L. KEHM 2409 W. 14' ST. GRAND ISLAND, NE 68803 Transfer on Death At my death, I transfer my interest in the described property to the beneficiaries as designated above. The transfer occurs at the death of the Transferor. Survivorship Required Under Nebraska law, the interest of a designated beneficiary is contingent on the designated beneficiary surviving the transferor by one hundred twenty hours. This TOD Deed is Revocable Before my death, I have the right to revoke this deed. Required Warnings in the TOD Deed: Please pay close attention to the following warnings. 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. Transfer on Death Deed - Page No. 2