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

(front of form)REVOCABLE TRANSFER ON DEATH DEEDNOTICE TO OWNERYou should carefully read all information on the other side of this form. Transferring real property by using a transfer on death deed may have important legal consequences in addition to designating who will receive the real property on the transferor's death. These consequences may include, but are not limited to, (1) affecting the beneficiary's eligibility for public assistance; and (2) affecting creditors' rights. If you have any questions, you should consult an attorney. This form must be recorded before your death, or it will not be effective.IDENTIFYING INFORMATIONOwner or Owners Making This Deed: Printed name Mailing addressMarital status Printed name Mailing addressMarital statusLegal description of the property:PRIMARY BENEFICIARY/BENEFICIARIES(Please list one or more primary beneficiaries. You may want to obtain legal advice before listing more than one primary beneficiary. There is more than one way to transfer property to several persons.)I designate the following beneficiary if the beneficiary survives me: Printed name Mailing address, if availableMarital statusALTERNATE BENEFICIARY/BENEFICIARIES - Optional(You may list one or more alternate beneficiaries. You may want to obtain legal advice before listing more than one alternate beneficiary. There is more than one way to transfer property to several persons.)If my primary beneficiary does not survive me, I designate the following alternate beneficiary if that beneficiary survives me: Printed name Mailing address, if availableMarital statusTRANSFER ON DEATHAt my death, I transfer my interest in the described property to the beneficiaries as designated above.Before my death, I have the right to revoke this deed.AUTHORITY OF DESIGNATED AGENT TO REVOKE THIS DEEDI authorize the following designated agent to revoke this deed before my death: Printed name Mailing addressSIGNATURE OF OWNER OR OWNERS MAKING THIS DEED Signature Date Signature Date ACKNOWLEDGMENTState of Judicial District (or County of or Municipality of )The foregoing instrument was acknowledged before me this (date) by (name of person who acknowledged). Signature of Person Taking Acknowledgment Title or Rank Serial Number, if any(back of form)COMMON QUESTIONS ABOUT THE USE OF THIS FORMWhat does the Transfer on Death (TOD) deed do? When you die, this deed transfers the described property, subject to any liens or mortgages (or other encumbrances) on the property at your death. Probate is not required. The TOD deed has no effect until you die. You can revoke it at any time. You are also free to transfer the property to someone else during your lifetime. If you do not own any interest in the property when you die, this deed will have no effect.How do I make a TOD deed? Complete this form. Have it acknowledged before a notary public or other individual authorized by law to take acknowledgments. Record the form in each recording district where any part of the property is located. The form has no effect unless it is acknowledged and recorded before your death.Is the “legal description” of the property necessary? Yes.How do I find the “legal description” of the property? This information may be on the deed you received when you became an owner of the property. This information may also be available in the office of the recorder in the recording district where the property is located. If you are not absolutely sure, consult a lawyer.Can I change my mind before I record the TOD deed? Yes. If you have not yet recorded the deed and want to change your mind, simply tear up or otherwise destroy the deed.How do I “record” the TOD deed? Take the completed and acknowledged form to the office of the recorder in the recording district where the property is located. Follow the instructions given by the recorder to make the form part of the official property records. If the property is in more than one recording district, you should record the deed in each recording district.Can I later revoke the TOD deed if I change my mind? Yes. You can revoke the TOD deed. Except for a court, no one, including the beneficiaries, can prevent you from revoking the deed.How do I revoke the TOD deed after it is recorded? There are three ways to revoke a recorded TOD deed: (1) Complete and acknowledge a revocation form, and record it in each recording district where the property is located. (2) Complete and acknowledge a new TOD deed that disposes of the same property, and record it in each recording district where the property is located. (3) Transfer the property to someone else during your lifetime by a recorded deed that expressly revokes the TOD deed. You may not revoke the TOD deed by will.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.Do I need to tell the beneficiaries about the TOD deed? No, but it is recommended. Secrecy can cause later complications and might make it easier for others to commit fraud.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, you are encouraged to consult a lawyer.