NOTICE TO OWNER

You should carefully read all information on the other side of this form. You may want to consult a lawyer before using this form.

This form must be recorded before your death or it will not be effective. The beneficiary must be a named person.

IDENTIFYING INFORMATION

Owner or Owners Making This Deed:

_______________________________     ______________________________

Printed Name                         Mailing Address

_______________________________     ______________________________

Printed Name                         Mailing Address

Legal Description of Property (Pursuant to Utah Code Section 57-3-105):

_________________________________________________________

Tax Identification Number for Property:

_________________________________________________________

PRIMARY BENEFICIARY

I designate the following beneficiary if the beneficiary survives me:

_______________________________     ______________________________

Printed Name                         Mailing Address

ALTERNATE BENEFICIARY (Optional)

If my primary beneficiary does not survive me, I designate the following alternate beneficiary if that beneficiary survives me:

_______________________________     ______________________________

Printed Name                         Mailing Address

TRANSFER ON DEATH

At 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.

SIGNATURE OF OWNER OR OWNERS MAKING THIS DEED

_______________________________     ______________________________

Signature                         Date

_______________________________

Printed Name     

_______________________________     ______________________________

Signature                         Date

_______________________________

Printed Name

ACKNOWLEDGMENT

(Attach an affidavit of acknowledgment pursuant to Utah Code Section 46-1-6.5 to the form.)

Terms Used In Utah Code 75-6-416

• Affidavit: A written statement of facts confirmed by the oath of the party making it, before a notary or officer having authority to administer oaths.
• Beneficiary: A person who is entitled to receive the benefits or proceeds of a will, trust, insurance policy, retirement plan, annuity, or other contract. ^{Source: OCC}
• Beneficiary: means a person who receives property under a transfer on death deed. See Utah Code 75-6-402
• Deed: The legal instrument used to transfer title in real property from one person to another.
• Individual: means a natural person. See Utah Code 75-6-402
• Person: means an individual, corporation, business trust, estate, trust, partnership, limited liability company, association, joint venture, public corporation, government or governmental subdivision, agency, or instrumentality, or any other legal or commercial entity. See Utah Code 75-6-402
• Property: means an interest in real property located in this state that is transferable on the death of the owner. See Utah Code 75-6-402
• Survive: includes its derivatives, such as "survives" "survived" "survivor" and "surviving. See Utah Code 75-1-201 v2
• Transfer on death deed: means a deed authorized under this part. See Utah Code 75-6-402
• Utah Code: means the 1953 recodification of the Utah Code, as amended, unless the text expressly references a portion of the 1953 recodification of the Utah Code as it existed:
       (42)(a) on the day on which the 1953 recodification of the Utah Code was enacted; or
       (42)(b)

            (42)(b)(i) after the day described in Subsection (42)(a); and

            (42)(b)(ii) before the most recent amendment to the referenced portion of the 1953 recodification of the Utah Code. See Utah Code 68-3-12.5