Fill and Sign the Transfer Death Deed Form 497299764

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 the following as Grantee Beneficiaries:       , whose address is       , as First Grantee Beneficiary;       , whose address is       , as Second Grantee Beneficiary;       , whose address is       , as Third Grantee Beneficiary;       , whose address is       , as Fourth Grantee Beneficiary; and       , whose address is       , as Fifth 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.) But, if the First Grantee Beneficiary fails to survive Grantor, Grantor designates       , whose address is       , as Successor Grantee Beneficiary; or If the Second Grantee Beneficiary fails to survive Grantor, Grantor designates       , whose address is       , as Successor Grantee Beneficiary; or If the Third Grantee Beneficiary fails to survive Grantor, Grantor designates       , whose address is       , as Successor Grantee Beneficiary; or If the Fourth Grantee Beneficiary fails to survive Grantor, Grantor designates       , whose address is       , as Successor Grantee Beneficiary; and If the Fifth Grantee Beneficiary fails to survive Grantor, Grantor designates       , whose address is       , as Successor Grantee Beneficiary. Beneficiary Deed - 1 - But, if after succeeding to the share of a non-surviving Grantee Beneficiary, any Successor Grantee Beneficiary fails to survive Grantor, their share shall: fail and be divided between the surviving Grantee Beneficiaries and Successor Grantee Beneficiaries, if any, OR their interest shall go to the non-surviving Successor Grantee Beneficiary’s estate. Grantor hereby transfers, sells, and conveys on grantor's death to the grantee- beneficiaries, 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:       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 Beneficiary Deed - 2 - 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 - 3 - EXHIBIT A       Exhibit A