Governor’s Deed

State of Ohio

Know All Men By These Presents: That,

Whereas, in connection with the construction of *Route and Section*, the State of Ohio, through the Department of Transportation, acquired the hereinafter described real property for highway purposes that is situated in the Choose an item. *Name of City/Village/Township*, *County* County, Ohio, from:

TRANSFEROR	PARCEL NO.	RECORDING DATA

*Name of Transferor*	*Parcel No.* -*Suffix(s)*	*Vol., Page, OR, etc.*

As recorded in Recorder’s Office of *County* County, Ohio; and

Whereas, the abovementioned *Route and Section* project has been constructed;

Whereas, the State of Ohio, through the Ohio Department of Transportation, has determined that Parcel No. *Parcel No.* -*Suffix(s)*, which is more particularly described in Exhibit A attached hereto, is no longer needed for highway purposes, and can be disposed of without affecting the integrity of said *Route and Section* and title to that parcel can be transferred pursuant to the statutory provisions of Chapter 5501 of the Ohio Revised Code;

Whereas, the State of Ohio, through the Ohio Department of Transportation, is required by the Ohio Environmental Protection Agency [hereinafter “OEPA”] and the United States Army Corps of Engineers [hereinafter “USACE”], pursuant to Sections 401 and 404 of the Clean Water Act, (33 U.S.C. 1251 et. seq.), to devote property to stream and/or wetland mitigation by issuing certifications and permits, respectively, for the unavoidable impacts to streams and/or wetlands resulting from the construction and maintenance of the Ohio’s state highways;

Whereas, the Director of Transportation has determined that a certain portion of the abovementioned Parcel No. *Parcel No.* -*Suffix(s)*, which is more particularly described in Exhibit B attached hereto, is capable of qualifying for such stream and/or wetland mitigation certifications and permits issued by OEPA and USACE, provided the use of the property described in said Exhibit B is restricted in the manner provided for in Exhibit C attached hereto, which restrictions shall run with the land in perpetuity.

Now Therefore: The State Of Ohio, By MIKE DEWINE, Governor, acting under the authority of Sections 117.50, 5301.13 and 5501.34 of the Ohio Revised Code, which established this transfer for the consideration of *Amount* Dollars (*$* ), does hereby remise, release and forever Quitclaim unto *Name(s) of Grantee(s)*, Choose an item. heirs, successors and assigns forever, all rights, titles and interests of the State of Ohio, except any and all limitations of access mentioned in Exhibit A attached hereto and with the area of real estate described Exhibit B being subject to the restrictions specified in Exhibit C, in the following described real estate to wit:

See Exhibit A Attached Hereto And By This Reference Made A Part Hereof

PARCEL(S): *Parcel No.* *Suffix(s)*

*CTY-RTE-SEC*

Prior Instrument Reference: *Volume, Page, OR, Microfiche, etc.,* *County* County Recorder’s Office.

To Have And To Hold said premises with all privileges and appurtenances thereunto belonging to *Name(s) of Grantee(s)*, Choose an item. heirs, successors and assigns forever.

Provided, however, if the *Name(s) of Grantee(s)* Choose an item. heirs, successors or assigns, should ever fail to comply with any of the restrictions specified in Exhibit C, then and that event the real estate described in Exhibit B Grantee shall be divested forthwith of all of the premises described in Exhibit B, and thereupon all of the rights, titles and interests in the premises described in Exhibit B conferred upon and vested in Grantee by this conveyance shall revert immediately to the State of Ohio, Department of Transportation.

In Testimony Whereof, I, Mike Dewine, Governor, for and in the name of the State of Ohio, have signed this deed at Columbus, Ohio, and have caused the same to be countersigned by the Secretary of State and the Great Seal of the State of Ohio to be hereunto affixed this the *# Spelled out* (*#*) day of Two Thousand _____________ (20___).

THE STATE OF OHIO

BY

_______________________________

MIKE DEWINE

GOVERNOR

COUNTERSIGNED

BY	________________________________

FRANK LAROSE

SECRETARY OF STATE

DRAFTED AND PREPARED

BY	_______________________________

KEITH FABER

AUDITOR OF STATE

PURSUANT TO R.C.§§ 117.50 & 501.34

Recorded in Volume *?*, Page *?* New Deeds Various State Lands

Land Office, Auditor of State