Project:
Code:
Parcel:
Page: / 2 of 4
Project:
Code:
Parcel:
Page: / 2 of 4

DELETE AFTER READING: Before entering data, “SAVE AS” under a separate file name. Use the TAB key to move to each field. Repeated info will auto-populate throughout the form. If the fields do not auto-update (page #), right-click and select Update Field.

QUIT CLAIM DEED

(MINERAL RIGHTS)

Form MQCD-1 / Project: / PROJECT #
Revised 07/2014 / Code: / CODE
Parcel: / PARCEL #
Page: / 1 of 3
Interests in land acquired by the Indiana Department of Transportation
Grantee mailing address:
I.C. 8-23-7-31

THIS INDENTURE WITNESSETH, That GRANTOR(S), the Grantor(s) of GRANTOR COUNTY County, State of GRANTOR STATERelease(s) and Quit Claim(s)to the STATE OF INDIANA, the Grantee, for and in consideration of the sum of DOLLAR AMOUNT (Text) Dollars ($0.00) and other valuable consideration, the receipt of which is hereby acknowledged, all right, title, interest and possessory rights which the Grantor(s) may have in certain Real Estate situated in the County of COUNTY OF PROPERTY, State of Indiana, and being more particularly described in the legal description(s) attached hereto as Exhibit “A” and the Right of Way Parcel Plat attached hereto as Exhibit “B”, which exhibits are incorporated herein by reference, together with any and all mineral rights (the term “minerals” including, but not being limited to, coal, gas, oil, peat, salt, sand, stone, aggregates, and all other such resources) and interests on, in and under the said Real Estate, and any right to mine, drill, explore, extract or in any way enter upon, or penetrate the surface of, the said Real Estate.

< insert jurat(s) here - otherwise delete >

Project:
Code:
Parcel:
Page: / 2 of 4
Form MQCD-1 / Project: / PROJECT #
Revised 07/2014 / Code: / CODE
Parcel: / PARCEL #
Page: / 2 of 3

IN WITNESS WHEREOF, the said Grantor(s) executed this instrument

this ______day of ______, ______.

COMPANY NAME

(Seal) / (Seal)
Signature / Signature
NAME, TITLE, IF APPLICABLE (or delete) / NAME, TITLE, IF APPLICABLE (or delete)
Printed Name / Printed Name
(Seal) / (Seal)
Signature / Signature
NAME, TITLE, IF APPLICABLE (or delete) / NAME, TITLE, IF APPLICABLE (or delete)
Printed Name / Printed Name

STATE OF:______:

SS:

COUNTY OF______:

Before me, a Notary Public in and for said State and County, personally appeared

______, theGrantor(s) in the above conveyance, and acknowledged the execution of the same on the date aforesaid to be voluntary act and deed and who, being duly sworn, stated that any representations contained therein are true.

Witness my hand and Notarial Seal this ______day of ______, ______.

Signature

Printed Name ______

My Commission expires ______

I am a resident of ______County.