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LPS - 11 (11/13)

FEDERAL PROJECT NO.
PROJECT NAME/ROUTE
COUNTY
MUNICIPALITY
PARCEL NO.
CLAIM NO.
CLAIMANT

Made onby owner(s) of property affected by the construction or improvement of the above mentioned highway,heirs, executors, administrators, successors, and/or assigns, hereinafter, whether singular or plural, called the GRANTOR, and the , hereinafter called the GRANTEE,

W I T N E S S E T H :

WHEREAS the GRANTEE a plan in the Recorder of Deeds Office of the aforesaid County indicating its authorization to condemn an aerial easement from the aforesaid property; and

WHEREAS the Parties hereto have agreed that, in lieu of condemnation, the GRANTOR will convey to the GRANTEEan aerial easement from the aforesaid property,

NOW, THEREFORE, in consideration of the sum of One Dollar ($1.00) and other good and valuable consideration, the GRANTOR does hereby grant and convey to the GRANTEEan aerial easement, which includes a surface easement for the accommodation of piers and other appurtenances and a temporary construction easement,between Stations and as shown on the plot plan attached hereto and made a part hereof, said easement to be taken from the premises conveyed or devised to the GRANTORby of dated recorded in , together with the improvements, hereditaments, and appurtenances to the said easement, if any, except those which may have been agreed to be retained by the GRANTOR.

LPS - 11 (2/13) Page 2 of 3

Claim NumberClaimantDate

The GRANTOR does further agree that the following limitations shall be imposed upon use of the surface land within the aerial easement, which limitations shall run with the land:

  1. No use shall be made of the land which shall endanger the structure of the highway, or the health, safety, or welfare of the traveling public.
  2. No flammable, explosive, dangerous, or hazardous material shall be used, placed, or stored on the land.
  3. No buildings or other facilities shall be constructed on the land without prior authorization of . If and when such authorization is granted, the plans of the building and construction methods shall be subject to the approval of .
  4. No interference shall be made with the right of to enter upon the land for the purposes of inspection, maintenance, repair, reconstruction, or alteration of the structure or other appurtenances.
  5. Any substantial change in land use to be made subsequent to the execution of the easement shall be subject to the approval of the Department of Transportation.

The GRANTOR does further remise, release, quitclaim, and forever discharge the GRANTEE or any agency or political subdivision thereof, or its or their employees or representatives, of and from all suits, damages, claims, and demands which the GRANTOR might otherwise have been entitled to assert under the provisions of the Eminent Domain Code, 26 Pa.C.S. § 101 et seq. , for or on account of any injury to or destruction of the aforesaid property of the GRANTOR through or by reason of the aforesaid highway construction or improvement, except damages, if any, under Section 710 (Limited Reimbursement of Appraisal, Attorney, and Engineering Fees) and 711 (Payment on Account of Increased Mortgage Costs) of the Eminent Domain Code; provided, however, that if relocation of a residence or business or farm operation is involved, this release shall likewise not apply to damages, if any, under Section 902 (Moving Expenses) and/or Section 903 and/or 904 (Replacement Housing) of the Eminent Domain Code.

The GRANTOR does further indemnify the GRANTEE against any claim by any lessee of the aforesaid property who has not entered into a Settlement Agreement with the GRANTEE.

Certificate of Residence

I hereby certify the Grantee’s precise residence to be:

Witness my hand this ______day of ______, ______

______

Agent for the GRANTEE
LPS - 11 (6/07) Page 3 of 3

Claim NumberClaimantDate

The GRANTOR has executed or caused to be executed these presents, intending to be legally bound thereby.


INDIVIDUALS / ENTITIES*
GRANTOR:
/ (Name of Entity)
BY:
BY:
* Use this block for a corporation, partnership, LLC, government entity, school district, church, trust, club, association, POA, attorney-in-fact, executor, administrator or any other entity.
INDIVIDUAL / ENTITY
STATE OF PENNSYLVANIA______
COUNTY OF ______
On this______day of______, 20____, before me,, the undersigned officer, personally appeared
______, known to me (or satisfactorily proven) to be the person(s) whose name(s) _____ subscribed to the within instrument, and acknowledged that ______executed the instrument for the purposes contained in it.
In witness whereof, I hereto set my hand and official seal.
______[Signature]
______[Title]
[Seal] / STATE OF PENNSYLVANIA______
COUNTY OF ______
On this ______day of ______, 20____, before me, ______, the undersigned officer, personally appeared ______, who acknowledged ______self to be the ______[title] of ______[name of entity], and thatas such [title], being authorized to do so, executed the foregoing instrument for the purposes contained in it by signing on behalf of the entity as ______[title].
In witness whereof, I hereto set my hand and official seal.
______[Signature]
______[Title]
[Seal]