Fill and Sign the In Witness Whereof the Grantor Has Executed This Form

Quitclaim Deed Page 1 of 3 QUITCLAIM DEED(Corporation 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, ______________________________, a Corporation organized under the laws of the state of ______________________, 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 ______ , P ag e _ _____ , D ocu m en t N o. _ _____ , o f t h e R eco rd er o f ______________________ County, West Virginia.LESS AND EXCEPT all oil, gas and minerals, on and under the above described property owned by Grantors, 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 heirs and assigns forever, with all appurtenances thereunto belonging. CO M PL ETE A LL A PPL IC A BLE S T A TEM EN TS: T he gra n to r(s ) here in does/d o here b y dec la re t h at t h is i s a t r a n sfe r e x em pt f ro m t h e e x cis e t a x ; U nder t h e p en altie s o f f in e a n d i m pris o nm en t a s pro vid ed b y la w , th e g ra n to r(s ) d oes/d o h ere b y d ecla re (s ) th at th e to ta l c o nsid era tio n fo r th e re al e sta te tra n sfe rre d b y t h is d ocu m en t i s _ _________________ D olla rs ( $ _ _________________ ). Quitclaim Deed Page 2 of 3IN WITNESS WHEREOF, this deed was executed by the undersigned on this the ____ day of __________________, 20___. CORPORATION NAME Attest: Secretary By: Signature and Title Type or Print Name COUNTY OF __________________ This instrument was acknowledged before me on __________________________ (date) by __________________________________ (name of officer), ______________________________ (title of officer) of _________________________________________ (name of corporation acknowledging) a ____________________________________________ (state of incorporation) corporation, on behalf of said corporation. ______________________________Notary PublicPrinted 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 in __________________ County.Given under my hand this ______ day of __________________ , 20______.Signature Type or Print NameNature 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