Consent for Right of Entry, State: Ohio

STATE AML PROGRAM

CONSENT FOR RIGHT OF ENTRY, STATE: OHIO INGRESS AND EGRESS COUNTY: (INDIVIDUAL) PROJECT: PROJECT NUMBER:

I/We, owner(s) (Owner, herein) of record of the following described property: acquired from on by instrument recorded in Volume , Page , deed records of County, Ohio, do hereby grant to the Division of Mineral resources Management, Department of Natural Resources, State of Ohio (the Division), and the agents, employees, and contractors retained by the Division, the right of ingress and egress on the above described lands.

Ingress and egress performed by the Division, and its agents, employees, and contractors retained by the Division is pursuant to Section 1513.27 of the Ohio Revised Code.

Subject to my/our continued ownership of the above-described property, I/we give this consent of ingress and egress to the Division, its agents, employees, and contractors for the length of time necessary to explore, restore, reclaim, abate, control, or prevent the adverse effects of coal mining practices and for two (2) additional years to monitor the reclamation work.

I/we assume no liability for injury or damage by or to employees and/or agents providing reclamation services for the Division.

I/We agree to contact and gain consent from lessees of surface interests in the above described property that the reclamation work will affect prior to the start of reclamation.

In giving my/our consent to this right-of-entry, I/We do not waive any of our legal remedies under Section 1513.27 of the Ohio Revised Code.

ALL CO-OWNERS OF THE PROPERTY MUST SIGN THIS RIGHT-OF-ENTRY AND EACH SIGNATURE MUST BE WITNESSED.

SIGNED, this day of choose one,

Name: Name:

Street Street Address: Address:

City: City:

State: Zip: State: Zip:

Phone: H) / Phone: (H) /

(W) / W) /

Witnessed By: Witnessed By:

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