The following form may be used to create an instrument of revocation under the Uniform Real Property Transfer on Death Act. The provisions of the Uniform Real Property Transfer on Death Act govern the effect of this or any other instrument used to revoke a transfer on death deed.

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(front of form) “REVOCATION OF TRANSFER ON DEATH DEED NOTICE TO OWNER This revocation must be recorded before you die or it will not be effective. This revocation is effective only as to the interests in the property of owners who sign this revocation.

IDENTIFYING INFORMATION Owner or Owners of Property Making This Revocation:

Printed name                                                 Mailing address Printed name                                                 Mailing address Legal description of the property:

REVOCATION I revoke all my previous transfers of this property by transfer on death deed. SIGNATURE OF OWNER OR OWNERS MAKING THIS REVOCATION Signature                                                        Date Signature                                                        Date ACKNOWLEDGMENT (insert acknowledgment here)” (back of form) “COMMON QUESTIONS ABOUT THE USE OF THIS FORM How do I use this form to revoke a Transfer on Death (TOD) deed? Complete this form. Have it acknowledged before a notary public or other individual authorized to take acknowledgments. Record the form in the public records in the office of the county clerk of each county where the property is located. The form must be acknowledged and recorded before your death or it has no effect.

How do I find the “legal description” of the property? This information may be on the TOD deed. It may also be available in the office of the county clerk for the county where the property is located. If you are not absolutely sure, consult a lawyer.

How do I “record” the form? Take the completed and acknowledged form to the office of the county clerk of the county where the property is located. Follow the instructions given by the county clerk to make the form part of the official property records. If the property is located in more than one county, you should record the form in each of those counties.

I am being pressured to complete this form. What should I do? Do not complete this form under pressure. Seek help from a trusted family member, friend or lawyer.

I have other questions about this form. What should I do? This form is designed to fit some but not all situations. If you have other questions, consult a lawyer.”