Utah Code § 75-6-417: Optional form of revocation.

(1) An individual may use the following form to create an instrument of revocation under this part:

FULL REVOCATION OF TRANSFER ON DEATH DEED

NOTICE TO OWNER

This revocation must be recorded before you die or it will not be effective. This revocation is effective only as to the interests in the property of owners who sign this revocation.

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:

_________________________________________________________

REVOCATION

I revoke all my previous transfers of this property by transfer on death 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.)

(2) The other sections of this part govern the effect of the form described in Subsection (1) or any other instrument used to revoke a transfer on death deed.