Beneficiary Deed

 Request Form

~

Grantor(s)/Owner(s) Full Legal Name(s):

__________________________________________________________________

__________________________________________________________________

Grantor(s) Mailing Address (no P.O. Boxes):

__________________________________________________________________

__________________________________________________________________

Grantee(s)/Beneficiary(ies) Full Legal Name(s) and

Percentage Ownership (if not stated will be equal):

___________________________________________________________  ____%

___________________________________________________________  ____%

___________________________________________________________  ____%

___________________________________________________________  ____%

___________________________________________________________  ____%

Grantee Mailing Address (address for one Grantee, no P.O. Boxes):

_________________________________________________________________

_________________________________________________________________

.

Form of Ownership To Be Held By Grantees/Beneficiaries:

     (a) Joint Tenants With Right of Survivorship  _______

     (b) Tenants In Common _______

.

Missouri County Where Real Property is Located:

______________________________________________________________

Missouri City Where Real Property is Located:

______________________________________________________________

Your Full Name:

______________________________________________________________

Your Mailing Address:

______________________________________________________________

______________________________________________________________

______________________________________________________________

Your Telephone Number:

_______________________________________________________

Your Signature:

_______________________________________________________

.

By signing above you agree this form will serve as the written agreement between yourself and Michael J. Denk, Attorney at Law, to provide the legal services required to draft and provide you with one (1) Beneficiary Deed at the cost of $195.00 per deed. The filing of your deed and the filing fee as charged by the appropriate Recorder of Deeds office will be your responsibility. No other legal services are being provided. If you have any questions or concerns please contact us prior to signing and returning this form. Thank you.

Fill in all information on this form and mail to our office:

 Missouri Beneficiary Deed c/o

 Michael J. Denk, Attorney at Law

 P.O. Box 6464, Chesterfield, MO 63006