(Top 3 inches reserved for recording data) SEVERANCE OF JOINT TENANCY Minnesota Uniform Conveyancing Blanks Form 10.3.8 (2011) DATE: (month/day/year) DEED TAX DUE: $ I, (insert name of owner severing joint tenancy) , am one of the owners in County, Minnesota, legally described as follows: joint tenancy of real property in Check here if all or part of the described real property is Registered (Torrens) In accordance with Minn. Stat. 500.19, subd. 5(1), I hereby sever and terminate the joint tenancy with the intention that I hold my interest in the real property as a tenant in common. Owner severing joint tenancy (signature) Page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com Page 2 of 2 Minnesota Uniform Conveyancing Blanks Form 10.3.8 State of Minnesota, County of This instrument was acknowledged before me on (month/day/year) (insert name of owner severing joint tenancy) , by . (Stamp) (signature of notarial officer) Title (and Rank): My commission expires: (month/day/year) THIS INSTRUMENT WAS DRAFTED BY: (insert name and address) TAX STATEMENTS FOR THE REAL PROPERTY DESCRIBED IN THIS INSTRUMENT SHOULD BE SENT TO: (insert legal name and residential or business address of Grantee) Note: This instrument will be legally effective only if recorded in the Office of the County Recorder or the Registrar of Titles, as applicable, in the county where the real estate is situated. American LegalNet, Inc. www.FormsWorkFlow.com