Fill and Sign the Nebraska Transfer Death Form

© 2018 - U.S. Legal Forms, Inc.       NEBRASKA REVOCABLE TRANSFER ON DEATH DEED [ Individual to Individual With Alternative Beneficiary ] Control Number: NE- 01-82 I. TIPS ON COMPLETING THE FORMS The form(s) in this packet may contain “form fields” created using Microsoft Word or Adobe Acrobat (“.pdf” format). “Form fields” facilitate completion of the forms using your computer. They do not limit your ability to print the form “in blank” and complete with a typewriter or by hand. It is also helpful to be able to see the location of the form fields. Go to the View menu, click on Toolbars, and then select Forms. This will open the Forms toolbar. Look for the button on the Forms toolbar that resembles a shaded letter “a”. Click this button and the form fields will be visible. By clicking on the appropriate form field, you will be able to enter the needed information. In some instances, the form field and the line will disappear after information is entered. In other cases, it will not. The form was created to function in this manner. II. NOTICE TO OWNER(S) / TRANSFEROR(S): 1. You should carefully read all the Warnings at the end of this Deed. 2. This Deed must be recorded (a) within thirty (30) days after being executed; (b) before the transferor’s death; and (c) in the public records in the office of the register of deeds of the County for the property is located. 3. This form must be recorded before your death(s), or it will not be effective. 4. After this transfer on death deed is recorded, it can be revoked only by an effective revocatory instrument recorded prior to the death of the transferor(s) and may not be revoked by a revocatory act taken against or on the original or a copy of the recorded transfer on death deed. 5. The execution and recordation of this transfer on death deed does not limit the effect of a transfer of the property by the transferor(s). III. 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After Recording, return to: Name: __________________________ _______________________________ Address: __________________________ _______________________________ _______________________________ REVOCABLE TRANSFER ON DEATH DEED [Individual to Individual] OWNER / TRANSFEROR : _______________________________ , whose address is ________________________________________ , TRANSFERS UPON HIS DEATH, the following property to the beneficiary named below: LEGAL DESCRIPTION OF THE PROPERTY:       Owner / Transferor designates the following BENEFICIARY, if the beneficiary survives the Owner / Transferor: Revocable Transfer on Death Deed Page 1 of 4 _______________________________ , whose mailing address is ________________________________________ . If the PRIMARY BENEFICIARY does not survive the Owner / Transferor , the Owner / Transferor designates the following ALTERNATE BENEFICIARY to take the property: _______________________________ , whose mailing address is ________________________________________ . If neither named Beneficiary survives the Owner / Transferor, this Deed fails and is null and void. Upon the death of the Owner /Transferor, the Beneficiary takes the property subject to all conveyances, encumbrances, assignments, contracts, mortgages, liens, and other interests to which the property is subject at the time. Prior to his or her death, the Transferor / Owner, has the right to revoke this deed. Executed on the day and year set forth below. Date: __________________________ Signature of Owner / Transferor _______________________________ Print or Type Name SELF-PROVING AFFIDAVIT I, _______________________________ the Owner / Transferor, sign my name to this instrument this       day of __________________________ , 20       , and being first duly sworn, do hereby declare to the undersigned authority that I sign and execute this transfer on death deed to transfer my interest in the described real property and that I sign it willingly or willingly direct another to sign for me, that I execute it as my free and voluntary act for the purposes therein expressed, that I am eighteen years of age or older or not at this time a minor, and that I am of sound mind and under no constraint or undue influence. (Transferor’s Signature) _______________________________ Print or Type Name We, _______________________________ and _______________________________ , Revocable Transfer on Death Deed Page 2 of 4 the witnesses, sign our names to this instrument, being first duly sworn, and do hereby declare to the undersigned authority that the transferor signs and executes this transfer on death deed to transfer his or her interest in the described real property and that he or she signs it willingly or willingly directs another to sign for him or her, and that he or she executes it as his or her free and voluntary act for the purposes therein expressed, and that each of us, in the presence and hearing of the transferor, hereby signs this deed as witness to the transferor's signing, and that to the best of his or her knowledge the transferor is eighteen years of age or older or is not at this time a minor and the transferor is of sound mind and under no constraint or undue influence. Signature of Witness Signature of Witness _______________________________ _______________________________ Print or Type Name Print or Type Name State of Nebraska , County of __________________________ Subscribed, sworn to, and acknowledged before me by _______________________________ , Owner / Transferor, and _______________________________ and _______________________________ , witnesses, this ______________ day of _______________________________ , 20       . Notary Public _______________________________ Type or Print Name My commission expires: __________________________ Revocable Transfer on Death Deed Page 3 of 4 WARNINGS Pursuant to Nebraska Revised Statutes 76-3410, the following Warnings are included as part of this transfer on death deed: WARNING: The property transferred remains subject to inheritance taxation in Nebraska to the same extent as if owned by the transferor at death. Failure to timely pay inheritance taxes is subject to interest and penalties as provided by law. WARNING: The designated beneficiary is personally liable, to the extent of the value of the property transferred, to account for Medicaid reimbursement to the extent necessary to discharge any such claim remaining after application of the assets of the transferor's estate. The designated beneficiary may also be personally liable, to the extent of the value of the property transferred, for claims against the estate, statutory allowances to the transferor's surviving spouse and children, and the expenses of administration to the extent needed to pay such amounts by the personal representative. WARNING: The Department of Health and Human Services may require revocation of this deed by a transferor, a transferor's spouse, or both a transferor and the transferor's spouse in order to qualify or remain qualified for medicaid assistance. Revocable Transfer on Death Deed Page 4 of 4