Fill and Sign the Change Registration Information for a Facility

Prepared by, recording requested by and return to:Name: Company: Address: City: State: Zip: Phone: Fax: ----------------------Above this Line for Official Use Only--------------------- MEMORANDUM AND NOTICE OF OPTION TO PUCHASE THIS notice is entered into and provided by ________________________________________, "Seller(s) and ______________________________________, “Buyer(s)”, on the date stated below.FOR VALUABLE CONSIDERATION, the receipt and sufficiency of which is hereby acknowledged, Buyer(s) grants to Seller(s) an exclusive option to purchase real property owned by Seller(s) and located in ________________ County, _____________________, such real property being more fully described as follows:SEE ATTACHED EXHIBITThe option is for a period of __________ ( ) years commencing on _______________________________ and ending on _____________________________. The option is subject to the terms and conditions of that certain option agreement between Seller(s) and Purchaser(s) dated the ______ day of ________________, _________. IN WITNESS WHEREOF, on this the ______ day of ____________, 2000.________________________________ Seller_____________________________________ Buyer________________________________ Seller_____________________________________BuyerSigned, sealed, and delivered in the presence of: ______________________________________________________ WitnessPrint Name______________________________________________________ Notary PublicPrint NameSigned, sealed, and delivered in the presence of:______________________________ ________________________ WitnessPrint Name______________________________________________________ Notary PublicPrint NameSeller Name and AddressBuyer Name and AddressName:Name:Address:Address:City:City:State: Zip:State: Zip:Phone:Phone:Seller Name and AddressBuyer Name and AddressName:Name:Address:Address:City:City:State: Zip:State: Zip:Phone:Phone: