Fill and Sign the Two Individuals to One Individual with Alternative Beneficiary Form

Transfer on Death Designation Affidavit Page 1 of 3 TRANSFER ON DEATH DESIGNATION AFFIDAVIT[Two Individuals to One Individual with Alternative Beneficiary] STATE of OHIO ) COUNTY of ) , a married individual, and , a married individual, currently owners of record of the following real property located at , , Ohio, as recorded at Volume , Page , of the County deed records: See Legal Description Attached as Exhibit A incorporated by reference as though set forth in full Legal Description: hereby designates the following as “Transfer on Death” Beneficiary to receive the owner’s title to that property upon the deaths of the owners: , whose street address is , in the City of , State of , and Zip Code of . If the designated TOD Beneficiary precedes either Owner in death, then (choose one) a. this transfer to the deceased Transfer on Death Beneficiary shall become null and void, OR Transfer on Death Designation Affidavit Page 2 of 3 b. ________________________ shall be substituted as the Alternative Transfer on Death Beneficiary in place of the deceased Transfer on Death Beneficiary. If the original Designated Transfer on Death Beneficiary and the alternative designated beneficiary do not survive me, this instrument is null and void. The above is intended to convey property known as: . Parcel # Alt Id# Prior Instrument Reference: I, wife husband of the grantor, release all rights of dower in the above described premises. I, wife husband of the grantor, release all rights of dower in the above described premises. WITNESS Grantor’s hands this the ____ day of ________________, 20____. Signed, Sealed and Delivered in the presence of: Witness Signature of First Grantor Type or Print Name Type or Print Name WitnessSignature of Spouse (if required) Type or Print Name Type or Print Name WitnessSignature of Second Grantor Type or Print Name Type or Print Name WitnessSignature of Spouse (if required) Type or Print Name Type or Print Name Transfer on Death Designation Affidavit Page 3 of 3 STATE OF OHIO,} ss before me a notary public, in and for said County, County } personally appear the above named Who acknowledged that he did sign the forgoing instrument, and that the same is his free act and deed. IN TESTIMONY WHEREOF I have hereunto set my hand and official seal, at , . This day of , A.D. 20 . Notary Public STATE OF OHIO,} ss before me a notary public, in and for said County, County } personally appear the above named Who acknowledged that he did sign the forgoing instrument, and that the same is his free act and deed. IN TESTIMONY WHEREOF I have hereunto set my hand and official seal, at , . This day of , A.D. 20 . Notary Public First Grantor’s Address: Second Grantor’s Address: First Grantee’s Address: This instrument prepared by and return to: Signature Print or Type Name Exhibit A EXHIBIT A