Fill and Sign the Ohio as Recorded at Volume Form

Transfer on Death Designation Affidavit Page 1 of 3 TRANSFER ON DEATH DESIGNATION AFFIDAVIT [Individual to Two Individuals] STATE of OHIO )COUNTY of ) , owner, a married individual, currently owner of record of the following real property located at , , Ohio as recorded at Volume , Page , of the County deed records: See Legal Description Attached as Exhibit A incorporated by reference as though set forth in full Legal Description: hereby designates the following as “Transfer on Death” Beneficiary to receive the owner’s title to that property, as tenants in common, upon the death of the owner: , whose street address is , in the City of , State of , and Zip Code of and , whose street address is , in the City of , State of , and Zip Code of . The above is intended to convey property known as: . Transfer on Death Designation Affidavit Page 2 of 3Parcel # Alt Id# Prior Instrument Reference: I, wife husband of the Owner/Affiant, release all rights of dower in the above described premises. WIT N ESS A ffia n t’ s h an d t h is t h e _ ___ d ay o f _ _______________ , 2 0 ____ .Signed, Sealed and Delivered in the presence of:Witness Signature Type or Print Name Type or Print NameWitness Signature of Spouse (if required) Type or Print Name Type or Print NameSTATE OF OHIO,} ss before me a notary public, in and for said County,County } personally appear the above named Who acknowledged that he did sign the forgoing instrument, and that the same is his free act and deed.IN TESTIMONY WHEREOF I have hereunto set my hand and official seal, at , . This day of , A.D. 20 . Notary Public Owner/Affiant’s Address: Transfer on Death Designation Affidavit Page 3 of 3First Beneficiary’s Address: Second Beneficiary’s Address: This Instrument was prepared by and return to: Signature Print or Type Name Exhibit A EXHIBIT A