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202605133 <br />This transfer on death deed is revocable and does not transfer any ownership interest until the death of the <br />owner. <br />WARNING: 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 subject to interest <br />and penalties as provided by law. <br />WARNING: 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 any such claim <br />remaining after application of the assets of the transferor's estate. The designated beneficiary may also <br />be personally liable, to the extent of the value of the property transferred, for claims against the estate, <br />statutory allowances to the transferor's surviving spouse and children, and the expenses of administration <br />to the extent needed to pay such amounts by the personal representative. <br />WARNING: 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 qualify or <br />remain qualified for medicaid assistance. <br />WARNING: 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 additional named <br />insured to the property insurance policy of the transferred property, any property insurance coverage of <br />the transferred property will end on the earliest to occur of the following after the transferor's death: The <br />end of the policy period as determined as if the transferor was still living; the date the designated <br />beneficiary obtains alternative coverage; or thirty days after the transferor's death only if any premium <br />required for the additional days beyond the policy period is paid. <br />Page 2 of 5 <br />