Fill and Sign the Date by Name of Person Acknowledged Form

Prepared by, recording requested by and return to: ---------------------- Above this Line for Official Use Only --------------------- Name: Company: Address: City: State: Zip: Phone: Fax: MEMORANDUM AND NOTICE OF LEASE AGREEMENT THIS notice is entered into and provided by ________________________________________, "Lessor(s) and ______________________________________, “Lessee(s)” , on the date stated below. FOR VALUABLE CONSIDERATION, the receipt and sufficiency of which is hereby acknowledged, Lessor(s) lease to Lessee(s) certain real property owned by Lesor(s) and located in ________________ County, _____________________, such r eal property being more fully described as follows: SEE ATTACHED EXHIBIT The lease is for a period of __________ ( ) years commencing on _______________________________ and ending on _____________________________. The lease is subject to the terms and conditions of that certain lease agreement between Lessor(s) and Lessee(s) dated the ______ day of ________________, _________. IN WITNESS WHEREOF, on this the ______ day of ____________, 2000. ________________________________ Lessor ____________ _________________________ Lessee ________________________________ Lessor _____________________________________ Lessee STATE OF KENTUCKY COUNTY OF ____________________ The foregoing instrument was acknowledged before me this _____________________ (date), by ______________________________________(name of person acknowledged). ______________________________ Notary Public Printed Name: _________________ My Commission Expires: _____________________ Serial Number, if any _________________ STATE OF KENTUCKY COUNTY OF ____________________ The foregoing instrument was acknowledged before me this _____________________ (date), by _________________________ _____________(name of person acknowledged). ______________________________ Notary Public Printed Name: _________________ My Commission Expires: _____________________ Serial Number, if any _________________ Lessor Name and Address Lessee Name and Address Name: Name: Address: Address: City: City: State: Zip: State: Zip: Phone: Phone: Lessor Name and Address Lessee Name and Address Name: Name: Address: Address: City: City: State: Zip: State: Zip: Phone: Phone: