Fill and Sign the Colorado Beneficiary Deed Form

Prepared by and return to: Send Tax Statements to:                                                 BENEFICIARY DEED (§§ 15-15-401, et seq. , Colorado Revised Statutes) [Individual to Two Individual Beneficiaries] CAUTION : THIS DEED MUST BE RECORDED PRIOR TO THE DEATH OF THE GRANTOR IN ORDER TO BE EFFECTIVE.       , as Grantor, designates the following as Grantee Beneficiaries:       , whose address is       , as First Grantee Beneficiary; and       , whose address is       , as Second Grantee Beneficiary. (Note to Assessor and Treasurer: These addresses are for identification purposes only, all notices and tax statements should continue to be sent to Grantor.) If either the Grantee Beneficiary fails to survive Grantor: the share of the deceased Grantee Beneficiary shall pass to their estate the share of the deceased Grantee Beneficiary shall pass to the surviving Grantee Beneficiary if that individual survives the Grantor. If both Grantee Beneficiaries fail to survive the Grantor, this Deed shall fail and the transfer is null and void. GRANTOR hereby transfers, sells, and conveys on Grantor's death to the Grantee- Beneficiaries, as tenants in common, the following described real property located in the County of       , State of Colorado: See Legal Description Attached as Exhibit A incorporated by reference as though set forth in full Legal Description: Beneficiary Deed Page 1 of 2       Known and numbered as: ________________________ THIS BENEFICIARY DEED IS REVOCABLE. IT DOES NOT TRANSFER ANY OWNERSHIP UNTIL THE DEATH OF THE GRANTOR. IT REVOKES ALL PRIOR BENEFICIARY DEEDS BY THIS GRANTOR FOR THIS REAL PROPERTY EVEN IF THIS BENEFICIARY DEED FAILS TO CONVEY ALL OF THE GRANTOR’S INTEREST IN THIS REAL PROPERTY. WARNING: EXECUTION OF THIS BENEFICIARY DEED MAY DISQUALIFY THE GRANTOR FROM BEING DETERMINED ELIGIBLE FOR, OR FROM RECEIVING MEDICAID UNDER TITLE 26, COLORADO REVISED STATUTES. WARNING: EXECUTION OF THIS BENEFICIARY DEED MAY NOT AVOID PROBATE. Executed this       day of       , 20       . Grantor       Type or Print Name The foregoing instrument was acknowledged before me this ______ day of __________________ , 20 ______ by ____________________________________ . Witness my hand and official seal. Signature / Title of Officer My Commission expires:             Type or Print Name Beneficiary Deed Page 2 of 2 EXHIBIT A       Beneficiary Deed Exhibit A