Prepared By:
________
________

QUITCLAIM DEED

On ________, THE GRANTOR, ________, a married individual, does enter into this agreement.

The Grantor, for and in consideration of the sum of $________ (________ dollars) and/or other good and valuable consideration, conveys, releases, and quitclaims to the following GRANTEE property described by this Deed:

--________, a married individual

The Grantor quitclaims the following described real estate, situated at the following address:

-- ________

The property being quitclaimed has the following legal description:

-- ________

The property being quitclaimed has the following tax parcel number:

-- ________

Future tax statements should be mailed to the following address:

-- ________
________

The Grantor does hereby convey, release, and quitclaim all of the Grantor's rights, title, and interest in and to the above described property and premises to the Grantee, and to the Grantee heirs and assigns forever, so that neither Grantor nor Grantor's heirs, legal representatives or assigns shall have, claim, or demand any right or title to the property, premises, or appurtenances, or any part thereof.

GRANTOR SIGNATURES:

________________________________________
________
________

___________________
Date

STATE OF ______________________, COUNTY OF ______________________:

On this ________ day of __________________________, __________, before me, ____________________________, personally appeared ________ known to me (or satisfactorily proven) to be the persons whose names are subscribed to the within instrument and acknowledged that they executed the same as for the purposes therein contained.

In witness whereof I hereunto set my hand and official seal.

______________________________
Notary Public

________________________
Title

My commission expires: _________________

NOTICE - THE GRANTEE, AS EVIDENCED BY THEIR SIGNATURE(S) TO THIS NOTICE AND THE ACCEPTANCE AND RECORDING OF THIS DEED, ARE FULLY AWARE OF THE FACT THAT THE GRANTEE(S) MAY NOT BE OBTAINING THE RIGHT OF PROTECTION AGAINST SUBSIDENCE AS TO THE PROPERTY CONVEYED TO THEM IN THIS DEED RESULTING FROM COAL MINING OPERATIONS AND THAT THE PURCHASED PROPERTY, HEREIN CONVEYED, MAY BE PROTECTED FROM DAMAGE DUE TO MINE SUBSIDENCE BY A PRIVATE CONTRACT WITH THE OWNERS OF THE ECONOMIC INTEREST IN THE COAL.

GRANTEES SIGNATURES

________________________________________
________
________

___________________
Date

STATE OF ______________________, COUNTY OF ______________________:

On this ________ day of __________________________, __________, before me, ____________________________, personally appeared ________ known to me (or satisfactorily proven) to be the persons whose names are subscribed to the within instrument and acknowledged that they executed the same as for the purposes therein contained.

In witness whereof I hereunto set my hand and official seal.

______________________________
Notary Public

________________________
Title

My commission expires: _________________

CERTIFICATE OF RESIDENCE

I, ________, do hereby certify that my precise residential address for annual real estate tax statements is the following address:

-- ________

_________________________________
________ signature

_______________
Date