Corporate or Entity Owner(s) / Code: / CODE
Revised 07/2014 / Parcel: / PARCEL #
gRANT TOIndiana Department of Transportation FOR eNTRY ONTO pRIVATE rEAL eSTATE
In consideration of the payment of One Thousand Dollars ($1,000.00) by the State of Indiana to GRANTOR(S), the undersigned owner(s) (“Owner”) of certain real estate situated inCOUNTY OF PROPERTY County, and located at , as more particularly described in the attached Exhibit A (the “Real Estate”), hereby GRANTS to the Indiana Department of Transportation(“INDOT”), its employees, agents, contractors, subcontractors and/or invitees, the right, privilege and authority to enter upon the Real Estate for the limited purpose of the following:
Tree cutting only.
In reliance upon Owner’s grant herein, (“INDOT”)will be incurring expenses related to cutting down any existing trees on the Real Estate. This grant shall be binding upon the undersigned Owner and his/her/its assigns, beneficiaries and heirs who may be successors to any interest in the Real Estate.
The undersigned agrees to deliver possession of the Real Estate to the Indiana Department of Transportation as of the ______day of ______, ______.This grant shall expire on the 1st day of April, 2014.
The undersigned person executing this grant represents and certifies on behalf of the Owner, that he/she is a duly elected officer of the Owner and has been fully empowered by proper resolution, or the by-laws of the Owner, to execute and deliver this grant; that the Owner is a corporation in good standing in the State of its origin and, where required, in the State where the subject real estate is situate; that the Owner has full corporate capacity to convey the interest described; and that all necessary corporate action for the making of this grant has been duly taken.
EXECUTED on this this ______day of ______, ______.
“OWNER”COMPANY NAME (or delete)
(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
Accepted and approved by the Indiana Department of Transportation on this day of, 2014.
Kathy Heistand, Director, Real Estate DivisionThis instrument prepared by: Michelle L. Kossmann, Deputy Attorney General, 302 West Washington Street, 5th Floor, Indianapolis, IN 46204.
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