__________ ("Owner") transfers, effective only upon Owner's death, the following real property in __________ County, State of __________:

__________

Commonly known as: __________.

Beneficiaries

__________

If a beneficiary does not survive Owner, that share passes to: __________.

Revocability

This deed may be revoked at any time before Owner's death. It does not affect Owner's ownership, right to sell, or right to mortgage the property during Owner's lifetime. This deed must be recorded before Owner's death to be effective.

Notary Acknowledgment

State of __________, County of __________.

On ____________________, before me, the undersigned notary public, personally appeared __________, proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to this instrument, and acknowledged that he/she/they executed the same.

Notary Public Signature: ______________________________ My Commission Expires: ____________