Polk County Transfer on Death Revocation (Individual Transferor) Form

A Nebraska transfer on death deed does nothing while the owner lives, and it keeps doing nothing right up to the moment the owner changes course. This form is that change of course for a deed one owner made alone: a recorded instrument of revocation, signed by that single transferor, cancelling the earlier transfer on death deed and every beneficiary designation standing in it.

Two dates decide whether the revocation works

Neb. Rev. Stat. section 76-3413(a)(2) makes an instrument of revocation effective only when the transferor acknowledges it after the acknowledgment of the deed being revoked, and only when it reaches the register of deeds before the transferor dies. Both conditions read against the earlier deed rather than the calendar, which is why Section 3 collects that deed's signing date, recording date, instrument or book and page number, and county of recording in four blanks. The form prints those two conditions in capital letters on its own face, where the register of deeds and any later title examiner read the same sentence.

One transferor, one designation cancelled

This version recites a sole transferor. One signature block carries that transferor's sworn declaration, two witness blocks follow, and a single officer certificate names the transferor and both witnesses together, in the pattern Neb. Rev. Stat. section 76-3409 prints. The configuration is narrow and complete at once: the recorded deed falls in its entirety as to that transferor's interest, including every alternate designation in it, while present ownership stays where it was. A single owner who recorded a beneficiary designation years earlier and now redirects the property, and a transferor whose medicaid eligibility review calls for the deed to come off the record, present the sole transferor pattern this instrument recites. A deed made by joint owners is a different pattern: section 76-3413(b)(2) revokes such a deed only when all living joint owners who were transferors revoke it.

Revocation is a listed instrument, not a gesture

Section 76-3413(a) is a closed list. An instrument revokes a recorded TOD deed only if it is a later transfer on death deed, an express instrument of revocation executed with the section 76-3409 formalities, an inter vivos deed, or an inter vivos deed to a bona fide purchaser, and only if the acknowledgment and recording conditions are met. This form is the second of those four; the other three are separate instruments, prepared and recorded on their own terms and not included in this package. Subsection (c) closes the informal route directly: after a transfer on death deed is recorded, it may not be revoked by a revocatory act on the deed, so marking or destroying the paper changes nothing in the record. A will is not on the list either.

The witness rule Nebraska carries over

Nebraska is one of the states that puts witnesses on a beneficiary deed, and section 76-3413(a)(1)(B) carries that formality straight into the revocation. The transferor signs, two or more disinterested witnesses attest in writing, and those signatures are made before an officer authorized to administer oaths, evidenced by the officer's certificate under official seal. Section 76-3402(3) defines a disinterested witness as an individual who witnesses at the date of execution and who is not a designated beneficiary or an heir, a child, or a spouse of a designated beneficiary. The form places the witness blocks and the certificate in that order, so the execution sequence happens in one sitting.

Recording, and the two filings that stay home

The instrument goes to the register of deeds of the county where the deed being revoked is recorded, which under section 76-3410(a)(4) is the county where the property sits. Section 33-109 sets ten dollars for the first page and six dollars for each additional page. The first page of this form reserves the top three inches for the recording stamp, with the return address and title below it as section 23-1510 contemplates. Two filings that ride along with most Nebraska deeds do not ride along here: under section 76-214(2)(b) Form 521, the Real Estate Transfer Statement, is not required when an instrument of revocation described in section 76-3413(a)(1)(B) is filed, and section 76-902(16) exempts revocations of transfer on death deeds from the documentary stamp tax.

The package includes the blank fillable form, a completed example filled with a Douglas County fact pattern, and a guide covering the statutes, each numbered section, signing, and recording. These materials are informational and are not legal advice; a Nebraska attorney can address a particular title.