The following form may be used to create a transfer on death deed. The provisions of this part govern the effect of this or any other instrument used to create a transfer on death deed.

REVOCABLE TRANSFER ON DEATH DEED

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Notice to Owner: This deed will transfer ownership of the property described below when you die. You should carefully read all of the information on this form. You should consult a lawyer before using this form.

This form must be recorded with the register of deeds before your death or it will not be effective. Any change to this deed must also be recorded to be effective.

Identifying Information

Owner(s) of Property Who Join in This Deed:

___________________________________________________________

___________________________________________________________

Address:

Marital Status of Owner(s):

Legal Description of Property:

__________

__________

__________

Beneficiary or Beneficiaries

I revoke all my prior transfer on death deeds concerning the property, and name the following beneficiary(ies) to receive the property (in equal shares, and as tenants in common, and not as joint tenants with rights of survivorship, unless I say otherwise):

Name and address of Beneficiary(ies)

___________________________________________________________

This transfer is ____ / is not______ subject to the requirement that the named beneficiary survive me by one hundred twenty hours.

Name and address of Contingent Beneficiary(ies)

___________________________________________________________

If no primary beneficiary survives me, I name the following contingent beneficiary(ies) to receive the property (in equal shares, and as tenants in common, and not as joint tenants with rights of survivorship, unless I say otherwise):

___________________________________________________________

___________________________________________________________

___________________________________________________________

Transfer on Death

I hereby convey and transfer upon my death all my interests (whether now owned or hereafter acquired) in the described property to the above listed beneficiary(ies).

Before my death, I may revoke this deed, or any part of this deed.

Exempt from Transfer Fee: § 43-4-22(18)

Signature(s) of Owner(s) Who Join in this Deed

__________ ______________________________

(signature) (date)

__________ ______________________________

(signature) (date)

Acknowledgment

(acknowledgment)

Source: SL 2014, ch 133, § 30.