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

(front of form)REVOCATION OF TRANSFER ON DEATH DEEDNOTICE 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 Making This Revocation: Printed name Mailing address, if availableMarital status Printed name Mailing address, if availableMarital statusLegal 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 DateACKNOWLEDGMENT State 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 FORMHow 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 recorder in each recording district 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 recorder in the recording district 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 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 located in more than one recording district, you should record the form in each of those recording districts.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.