Fill and Sign the Grantor Does Hereby Remise Release and Forever Quitclaim Both in Law and Equity Unto Form

Quitclaim Deed Page 1 of 3 QUITCLAIM DEED (Individual to LLC) KNOW ALL MEN BY THESE PRESENTS THAT: FOR VALUABLE CONSIDERATION OF TEN DOLLARS ($10.00), and other good and valuable consideration, cash in hand paid, the receipt and sufficiency of which is hereby acknowledged, ______________________________ , an Individual, married unmarried, hereinafter referred to as “Grantor”, does hereby remise, release, and forever quitclaim, both in law and equity, unto ______________________________, a Limited Liability Company organized under the laws of the state of _______________ , hereinafter “Grantee”, the following lands and property, together with all improvements located thereon, lying in the County of ______________________, State of West Virginia, to-wit: See Legal Description Attached as Exhibit A incorporated by reference as though set forth in full Legal Description: Prior instrument reference: Book ______, Page ______, Document No. ______, of the Recorder of ______________________ County, West Virginia. LESS AND EXCEPT all oil, gas and minerals, on and under the above described property owned by Grantor, if any, which are reserved by Grantor. SUBJECT to all easements, rights-of-way, protective covenants and mineral reservations of record, if any. TO HAVE AND TO HOLD same unto Grantee, and unto Grantee’s assigns forever, with all appurtenances thereunto belonging. COMPLETE ALL APPLICABLE STATEMENTS: The grantor(s) herein does/ do hereby declare that this is a transfer exempt from the excise tax; Under the penalties of fine and imprisonment as provided by law, the grantor(s) does/do hereby declare(s) that the total consideration for the real estate transferred by this document is __________________ Dollars ($ __________________). Quitclaim Deed Page 2 of 3 WITNESS Grantor(s) hand(s) this the ____ day of ________________, 20____. (1st Grantor’s Signature) Print Name STATE OF _________________________ COUNTY OF _________________________ This instrument was acknowledged before me on _________________________ (date) by __________________________________________ (name or names of person or persons acknowledging). ______________________________ Notary Public Printed Name: ___________________ My Commission Expires: ___________________ DECLARATION OF CONSIDERATION OR VALUE I hereby declare: (a) The total consideration paid for the property conveyed by the document to which this declaration is appended is $________________________; or (b) The true and actual value of the property transferred by the document to which this declaration is appended is, to the best of my knowledge and belief $________________________; or (c) The proportion of all the property included in the document to which this declaration is appended which is real property located in West Virginia is ____________%; the value of all the property $________________________; the value of real estate in West Virginia is $________________________; or Quitclaim Deed Page 3 of 3 (d) This deed conveys real estate located in more than one county in West Virginia; the total consideration paid for, or actual cash value of, all the real estate located in West Virginia conveyed by this document is $________________________; and documentary stamps showing payment of all of the excise tax on all of said real estate are attached to an executed counterpart of this deed recorded i n __________________ County. Given under my hand this ______ day of __________________, 20______. Signature Type or Print Name Nature of Interest in Conveyance: Grantor Grantee Other Specify: Prepared by and after Recording Return to: Name: ___________________ Firm/Company: ___________________ Address: ___________________ Address 2: ___________________ City, State, Zip: ___________________ Phone: ___________________ Preparer’s signature: ______________________________ Grantor(s) Name, Address, phone: Grantee(s) Name, Address, phone: SEND TAX STATEMENTS TO GRANTEE Quitclaim Deed Exhibit A EXHIBIT A