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202604474 <br />Required Warnings in the TOD Deed: <br />Please pay close attention to the following warnings. <br />Warning: <br />The property transferred remains subject to inheritance taxation in Nebraska to the same <br />extent as if owned by the transferor at death. Failure to timely pay inheritance taxes is <br />subject to interest and penalties as provided by law. <br />Warning: <br />The designated beneficiary is personally liable, to the extent of the value of the property <br />transferred, to account for Medicaid reimbursement to the extent necessary to discharge <br />any such claim remaining after application of the assets of the transferor's estate. The <br />designated beneficiary may also be personally liable, to the extent of the value of the <br />property transferred, for claims against the estate, statutory allowances to the transferor's <br />surviving spouse and children, and the expenses of administration to the extent needed to <br />pay such amounts by the personal representative. <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 Owner Making This Transfer on Death Deed <br />I, Michael J. Voss, a single person, the transferor, sign my names to this instrument on <br />- , 2026, and being first duly sworn, do hereby declare to the undersigned <br />authority that I sign and execute this transfer on death deed to transfer my interest in the described <br />real property and that I sign it willingly or willingly direct another to sign for me, that I execute it <br />as my free and voluntary act for the purposes therein expressed, that I am eighteen years of age or <br />older or am not at this time a minor, and that I am of sound mind and under no constraint or undue <br />influence. <br />MICHAEL J. VOSS, Transferor <br />Transfer on Death Deed - Page No. 3 <br />