Print, Complete and Mail in this Request Form
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Missouri 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)
Percentage Ownership (if not stated will be equal)
Relationship to the Grantor(s)/Owner(s)
____________________________________________________________________ ______%
Name of Grantee/Beneficiary
_____________________________________________
Relationship to Grantor(s)/Owner(s)
____________________________________________________________________ ______%
Name of Grantee/Beneficiary
_____________________________________________
Relationship to Grantor(s)/Owner(s)
____________________________________________________________________ ______%
Name of Grantee/Beneficiary
_____________________________________________
Relationship to Grantor(s)/Owner(s)
____________________________________________________________________ ______%
Name of Grantee/Beneficiary
_____________________________________________
Relationship to Grantor(s)/Owner(s)
Mailing Address of one Grantee (no P.O. Boxes)
_____________________________________________________________________________
_____________________________________________________________________________
If a Grantee/Beneficiary should predecease the Grantor
(for explanation see #3 and #4 on the Information Page)
(a) No LDPS_______
(b) LDPS_______
Form of Ownership to be held by Grantees/Beneficiaries
(for explanation see #5 on Information Page)
(a) Joint Tenants with Right of Survivorship _______
(b) Tenants in Common _______
Missouri County where the Real Property is located
___________________________________________________________________________
Address of Real Property
___________________________________________________________________________
___________________________________________________________________________
Your Full Name and Relationship to Owner(s)
___________________________________________________________________________
Your Mailing Address
___________________________________________________________________________
___________________________________________________________________________
Your Telephone Number
___________________________________________________________________________
Your Signature*
___________________________________________________________________________
Signatures of all Grantors/Owners*
___________________________________________________________________________
___________________________________________________________________________
(*Signatures Required - by signing this form you acknowledge
and agree to the Important Notes as set forth below.)
IMPORTANT NOTES*
1. By signing this form you agree this form will serve as the complete written agreement between yourself and Missouri Beneficiary Deed, LLC, to provide you with one (1) Missouri Beneficiary Deed (at the cost of $195) per your request and based upon the information you provide on this request form.
2. The proper signing of your Missouri Beneficiary Deed in the presence of a notary public and the recording of your Missouri Beneficiary Deed and the fee charged by your local County Recorder of Deeds office to record such deed will be and is your responsibility.
3. You understand and agree no legal advice has been provided to you and no legal services have been provided to you. Consult with an Attorney of your choice for legal advice and a review of your particular legal concerns and affairs.
4. In your behalf and on behalf of your estate you hereby release and hold harmless Missouri Beneficiary Deed, LLC, and Michael J. Denk, Attorney at Law, from any and all claims relating to your request, use and implementation of such Missouri Beneficiary Deed.