Fill and Sign the Colorado Transfer Death Form

Beneficiary Deed- 1 - BENEFICIARY DEED (§§ 15-15-401, et seq., Colorado Revised Statutes) CAUTION : THIS DEED MUST BE RECORDED PRIOR TO THE DEATH OF THE GRANTOR IN ORDER TO BE EFFECTIVE. , as Grantor, designates , whose address is , as Grantee Beneficiary. (Note to Assessor and Treasurer: This address is for identification purposes only, all notices and tax statements should continue to be sent to grantor.) If the Grantee Beneficiary fails to survive Grantor, Grantor designates , whose address is , as Successor Grantee Beneficiary. But, if after succeeding the non-surviving Grantee Beneficiary, if the Successor Grantee Beneficiary fails to survive Grantor: this deed is void, OR their interest shall go to the non-surviving Successor Grantee Beneficiary’s estate. Grantor transfers, sells, and conveys on grantor's death to the Grantee Beneficiary, 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- 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) Beneficiary Deed- 3 - STATE OF COLORADO COUNTY OF 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 Exhibit A EXHIBIT A