RE-56	C/R/S
Parcel No.	-
Rev. 01/2010	Pid No.
DISCLAIMER
(Name of Owners) is the fee owner (hereinafter “Owner”) of certain land required for the construction and maintenance of the highway project described above and being designated as Highway Parcel No. - disclaims any and all interest in and ownership of the following improvement(s) located upon the previously described parcel:
and states that the actual owner(s) of the improvement(s) described above is/are: . A copy of the Property Inventory Classification form (RE-95) is attached. It is understood that this Disclaimer does not in any manner prejudice or waive Owner’s rights with respect to the acquisition of the Owner’s real property by the State of Ohio. IN WITNESS WHEREOF, the said Owner, has executed this Disclaimer on the day of 20 .
Witness: Owner: (Print name of Witness) (Print name of Owner) Date

Owner:
(Print name of Owner)
Date