Fill and Sign the Day of Personally Appeared 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 real 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 INDIANA COUNTY OF __________________ Before me, the undersigned, a Notary Public, in and for said County and State, this __________ day of _________________, _________, personally appeared _________________________________________, said person being over the age of 18 years, and acknowledged the execution of the foregoing instrument. ___________________________ Notary Public Print Name: _________________ My commission expires: _____________________ STATE OF INDIANA COUNTY OF __________________ Before me, the undersigned, a Notary Public, in and for said County and State, this __________ day of _________________, _________, personally appeared _________________________________________, said person being over the age of 18 years, and acknowledged the execution of the foregoing instrument. ___________________________ Notary Public Print Name: _________________ My commission expires: _____________________ 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: