Address (Street Address of Property)

Owner Address

Route County Job No. Parcel No. P.I.N. No. Section Project No. Station Station Contract No. Catalog No.

TENANT’S RELEASE OF LEASE AND CONSENT TO A TEMPORARY CONSTRUCTION EASEMENT

(“Tenant”) is the tenant under a certain lease (“Lease”) with (“Property Owner”), dated , , and, if applicable, recorded on in the Office of the Recorder/Recorder of Deeds of County, Illinois.

Tenant acknowledges that Property Owner intends to convey to the People of the State of Illinois, Department of Transportation (IDOT) a portion of the property subject to the Lease located in County, Illinois and legally described as follows:

Tenant, in consideration of the sum of One Dollar ($1.00), receipt of which is hereby acknowledged, conveys, releases and quitclaims unto Property Owner and IDOT all the estate, title and interest to the above-described property that Tenant may have acquired under the Lease.

AND, IN ADDITION

Tenant acknowledges that Property Owner intends to convey to the People of the State of Illinois, Department of Transportation (IDOT) a temporary construction easement over and across a portion of the property subject to the lease located in County, Illinois and legally described as follows:

Tenant, in consideration of the sum of One Dollar ($1.00), the receipt of which is hereby acknowledged, agrees and consents to the provisions of the temporary construction easement between and IDOT for the purpose of .

Dated this day of , .

of 2 (Rev. 11/11) By: By: Signature Signature

Print Name Print Name

State of ) ) ss County of )

This instrument was acknowledged before me on by .

(SEAL) Notary Public

My Commission Expires:

This instrument was prepared by and return to: Illinois Department of Transportation ATTN: Bureau of Land Acquisition

of 2 (Rev. 11/11)