Fill and Sign the Wisconsin Beneficiary Form

Name and return address: DECEDENT ’S NAME DATE OF DEATH ADDRESS OF DECEDENT AT DATE OF DEATH CITY ST ZIP Interest in property is terminated under: s.867.046 which pertains to nonprobate transfer of real property under 705.15. An interest in real property may be transferred without probate to a designated TOD beneficiary on the death of the sole owner or last to die of multiple owners. (You must provide a copy of the document establishing interest in property.) Presentation of recorded document establishing interest in real estate. Parcel Identification Number DOCUMENT # VOLUME/REEL PAGE/IMAGE RECORDS/DEEDS Description of the real estate. See Attached DECLARATION: I(We) declare that this document is, to the best of my(our) knowledge and belief, true, correct and complete and is in conformity with the provisions and limitations of the Wisconsin Statutes. (If more space is needed, attach pages.) Name and Address (List all beneficiaries) Applicant’s Interest in Property (ie: beneficiary) Applicant Signature(Notarized ) (Print or type name below signature) Date STATE OF WISCONSIN, County of Subscribed and sworn to before me on: by the above named person(s): Signature of Notary or other person authorized to administer an oath (as per s 706.06, 706.07) Print or type name: This document was drafted by:(print or type name below) Title: Date Commission Expires: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED . TRANSFER ON DEATH TO BENEFICIARY Use black ink PRESENTATION OF DEATH CERTIFICATE I certify that I have viewed a certified copy of the decedent’s death certificate. ____________________________________ _______________ REGISTER OF DEEDS SIGNATURE DATE Recording area NOTE: SEE DIRECTIONS. Wisconsin Register of Deeds Association Form TOD-110 Website Version 03/2007