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202604851 <br />Amanda L. Lathen <br />3330 C Street <br />Lincoln, NE 68510 <br />TRANSFER ON DEATH <br />At the Grantor's death, Grantor transfers Grantor's interest in the described property to the Primary <br />Beneficiary or Alternate Beneficiary as designated above. The transfer occurs at the death of the Grantor. <br />SURVIVORSHIP REQUIRED <br />Under Nebraska law, the interest of a designated beneficiary is contingent on the designated beneficiary <br />surviving the Transferor by one hundred twenty hours. <br />TRANSFER ON DEATH DEED REVOCABLE <br />Before Grantor's death, Grantor has the right to revoke this deed. <br />LEGALLY REQUIRED WARNINGS <br />WARNING: The property transferred remains subject to inheritance taxation in Nebraska to the <br />same extent as if owned by the Grantor at death. Failure to timely pay inheritance taxes is subject <br />to interest and penalties as provided by law. <br />WARNING: The designated Beneficiary is personally liable, to the extent of the value of the <br />property transferred, to account for Medicaid reimbursement to the extent necessary to discharge <br />any such claim remaining after application of the assets of the Grantor's estate. The designated <br />beneficiary may also be personally liable, to the extent of the value of the property transferred, for <br />claims against the estate, statutory allowances to the Grantor's surviving spouse and children, and <br />the expenses of administration to the extent needed to pay such amounts by the personal <br />representative. <br />WARNING: The Department of Health and Human Services may require revocation of this deed <br />by a Grantor, a Grantor's spouse, or both a Grantor and the Grantor's spouse in order to qualify or <br />remain qualified for Medicaid assistance. <br />WARNING: Property insurance on the transferred property may expire thirty days after the death <br />of the 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 property <br />insurance coverage of the transferred property will end on the earliest to occur of the following <br />after the transferor's death: The end of the policy period as determined as if the transferor was still <br />living; the date the designated beneficiary obtains alternative coverage; or thirty days after the <br />transferor's death only if any premium required for the additional days beyond the policy period is <br />paid. <br />SIGNATURE OF OWNER MAKING THIS TRANSFER ON DEATH DEED <br />I, Robert L. Lathen, the Grantor, sign my name to this instrument this !e day of Awl3, <br />2026, and being first duly sworn, do hereby declare to the undersigned authority that I sign a execute this <br />Page 2 of 3 <br />