Fill and Sign the As Grantors Do Hereby Remise Release and Quitclaim Unto a Limited Form

- Quitclaim Deed - Page 1 - This document prepared by (and after recording return to):Name: Firm/Company: Address: Address 2: City, State, Zip: Phone: )))))))--------Above This Line Reserved For Official Use Only------------- QUITCLAIM DEED(Two Individuals to LLC) KNOW ALL MEN BY THESE PRESENTS THAT: FOR VALUABLE CONSIDERATION OF TEN DOLLARS ($10.00), and other good and valuable consideration, cash in hand paid, the receipt and sufficiency of which is hereby acknowledged, ________________________ and ________________________, Two Individuals, hereinafter referred to as “Grantors”, do hereby remise, release, and quitclaim unto ________________________, a Limited Liability Company organized under the laws of the state of _______________, hereinafter “Grantee”, the following lands and property, together with all improvements located thereon, lying in the County of ______________________, State of New York, to-wit: See Legal Description Attached as Exhibit A incorporated by reference as though set forth in full Legal Description: Prior instrument reference: Book _ _____ , P ag e _ _____ , D ocu m en t N o. _ _____ , o f t h e R eco rd er o f ______________________ County, New York.LESS AND EXCEPT all oil, gas and minerals, on and under the above described property owned by Grantors, if any, which are reserved by Grantors.SUBJECT to all easements, rights-of-way, protective covenants and mineral reservations of record, if any. GRANTORS, in compliance with Section 13 of the Lien Law, covenants that the Grantor will receive the consideration for this conveyance and will hold the right to receive such consideration as a trust fund to be applied first for the purpose of paying the cost of the improvement and will apply the - Quitclaim Deed - Page 2 - same first to the payment of the cost of the improvement before using any part of the total of the same for any other purpose.TO HAVE AND TO HOLD same unto Grantee, and unto Grantee’s assigns forever, with all appurtenances thereunto belonging.WIT N ESS G ra n to rs h an d(s ) t h is t h e _ ___ d ay o f _ _______ ________ , 2 0____ .__________________________________ Grantor{Type Name} __________________________________ Grantor{Type Name} CERTIFICATE OF ACKNOWLEDGMENT Use Within the State of New YorkUse Outside the State of New York State of New YorkState of New YorkCounty of County of On ________________________, before me, the undersigned, personally appeared ______________________________ personally known to me or proved to me on the basis of satisfactory evidence to be the individual(s) whose name(s) is (are) subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their capacity(ies), and that by his/her/their signature(s) on the instrument, the individual(s), or the person upon behalf of which the individual(s) acted, executed the instrument.On ________________________, before me, the undersigned, personally appeared ______________________________ personally known to me or proved to me on the basis of satisfactory evidence to be the individual(s) whose name(s) is (are) subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their capacity(ies), and that by his/her/their signature(s) on the instrument, the individual(s), or the person upon behalf of which the individual(s) acted, executed the instrument and that such individual made such appearance before the undersigned in ________________________ (insert city or political subdivision and state or county or other place acknowledgment taken )(signature and office of individual taking acknowledgment)(signature and office of individual taking acknowledgment) Type or Print NameType or Print Name - Quitclaim Deed - Page 3 - Names and address of the Grantors:Name: Address: City/State/Zip: Name: Address: City/State/Zip: Name and Address of Grantee:Name: Address: City/State/Zip: Exhibit APage 1 of 1 EXHIBIT A