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CASH CHECK 2- Uo 1HST 7 l5 01 S 21 REFUNDS: CASH .CORDS§HECK HALL. COUNTY ME 10t5 iD 1:b WOLD REGISTER OF DEEDS 00 Return to: Carissa D. Mobley, Attorney /Q.A1 159 N. Wolcott, Suite 400 Casper, WY 82601 REVOCABLE TRANSFER ON DEATH DEED Notice to Owner: You should carefully read all information on this form. You may want to consult a Lawyer before using this Form. If you are married and both spouses do not sign this deed, the deed may be void. This form must be recorded with the Register of Deeds of the County in which the property is located before your death and it also must be recorded with the Register of Deeds of the County in which the property is located within 30 days after it was signed. If either of these requirements is not met, this form will not be effective. Identifying Information about Owner: Names of Owner: Larry L. Jeratowski Trudy K. Jeratowski Mailing Address of Owner: 3780 Arroyo Drive Casper, WY 82604 Notice to Register of Deeds: This is a transfer on death deed and Form 521 is not required with the filing of this Transfer on Death deed under Neb. Rev. Stat. §76-214(2)(b). Legal Description: The following real estate is transferred by this document, effective at the death of the Owners to the Primary Beneficiary or to the appropriate Alternate Beneficiary as provided below. Lot One (1), Country Meadows Second Subdivision, In The City Of Grand Island, Hall County, Nebraska Primary Beneficiary: We designate the following beneficiaries of this revocable transfer on death deed if the beneficiaries survive the survivor of us. Names of Owner: Mailing Address of Owner: Marcia Stehlik 1976 County Road "E" Crete, NE 68333 Transfer on Death: At the death of the survivor of us, we transfer our interest in the described property to the beneficiaries as designated above. The transfer occurs at the death of the survivor of the Transferors. The beneficiaries shall own the property as tenants in common. Survivorship Required: Under Nebraska Law, the interest of a designated beneficiary is contingent on the designated beneficiary surviving the transferor by one hundred twenty (120) hours. This TOD Deed is Revocable: Before my death, I have the right to revoke this deed. Growing Crops: If this land is agricultural land the growing crops shall pass to: X My primary or alternate beneficiary My estate I understand that if I make no choice growing crops pass to my estate. 1