Fill and Sign the Checklist for Determining Complexity of Project Iowa Dot Form

1 Indexing Instructions: ___________________ STATE OF ______________ COUNTY OF ____________RIGHT_OF_WAY INSTRUMENT KNOW ALL MEN BY THESE PRESENTS THAT ___________________, his/her heirs, successors and assigns for valuable consideration of One Dollar, in hand paid, and other good and valuable consideration of the receipt and sufficiency of which is hereby acknowledged does hereby put, assign, convey unto and warrant and defend ________________________ and its' successor and assigns, collectively "Grantee", a non-exclusive right-of-way, servitude and easement for the purpose of _______________, over the following described property located in the County of _______, State of ________________, described as follows, to-wit: [describe property or right of way] Unless otherwise herein specifically provided, the centerline of the road to be constructed on this property shall be the center line of said right-of-way. Grantee shall indemnify and hold Grantor harmless for all claims for injuries and damages caused by the use of said right-of-way by Grantee. Grantee shall make the following improvements to sad right-of-way and shall maintain said improvements in a reasonable condition, to wit: [describe improvements] IN WITNESS WHEREOF, Grantor has executed this Right-of-Way Instrument on this the _____ day of ___________________, _____. GRANTOR GRANTEE 2 STATE OF ______________ COUNTY OF ____________Personally appeared before me, the undersigned authority in and for the said County and State, on this ______________ day of ______________________, ____, within my jurisdiction, the within named __________________, Grantor, who acknowledged that he executed, signed and delivered the above and foregoing instrument on the date there provided. NOTARY PUBLIC My Commission Expires: STATE OF ______________ COUNTY OF ____________Personally appeared before me, the undersigned authority in and for the said County and State, on this ______________ day of ______________________, ____, within my jurisdiction, the within named __________________, Grantor, who acknowledged that he executed, signed and delivered the above and foregoing instrument on the date there provided. NOTARY PUBLIC My Commission Expires: [if corporation] STATE OF ______________ COUNTY OF ____________Personally appeared before me, the undersigned authority in and for the said County and State, on this ____ day of ___________________, ____, within my jurisdiction, the within named __________________, who acknowledged that he is President of __________________, a corporation and that for and on behalf of the said corporation, and as its act and deed, he executed the above and foregoing instrument, after first having been duly authorized by said corporation so to do. NOTARY PUBLIC My Commission Expires: