Fill and Sign the Husband and Wife Two Individuals to Husband and Wife Two Individuals Form

Beneficiary Deed Page 1 of 3Prepared by and return to: Send Tax Statements to: BENEFICIARY DEED (§§ 15-15-401, et seq., Colorado Revised Statutes) [Husband and Wife / Two Individuals to Husband and Wife / Two Individuals] CAUTION: THIS DEED MUST BE RECORDED PRIOR TO THE DEATH OF THE GRANTORS, AND EACH OF THEM, IN ORDER TO BE EFFECTIVE. and ,Husband and Wife, as Grantors, designate 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 any Grantee Beneficiary, but NOT all, fail to survive Grantors: the share of the deceased Grantee Beneficiary shall pass to their estate, or the share of the deceased Grantee Beneficiary shall pass to the surviving Grantee Beneficiary(ies) that survive the Grantors. If ALL Grantee Beneficiaries fail to survive the Grantors, this Deed shall fail and the transfer is null and void.GRANTORS hereby transfer, sell, and convey on the death of the last Grantor 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 2 of 3Known and numbered as: THIS BENEFICIARY DEED IS REVOCABLE. IT DOES NOT TRANSFER ANY OWNERSHIP UNTIL THE DEATH OF THE LAST GRANTOR. IT REVOKES ALL PRIOR BENEFICIARY DEEDS BY THESE GRANTORS 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 GRANTORS 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.Date: Date: (1st Grantor’s Signature)(2nd Grantor’s Signature) Print Name Print NameState 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 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