Fill and Sign the R1 54091710doc Us Forest Service Form

SUPPLEMENTAL RIGHT OF WAY AGREEMENT(To Amend Original Agreement) STATE: COUNTY: This Supplemental Agreement is between _____ (the “Grantor”), and _____ (the “Grantee”). By Right of Way Grant dated _____, recorded in Volume _____, page _____ of the _____ Records of _____ County, _____ (the “Original Grant”), Grantor granted and conveyed to Grantee a right of way (the “Original Right of Way”) and perpetual easement for a pipe line across Grantor’s property, described in the Original Right of Way. At the request of Grantee, Grantor has consented and agreed (as to the lands or portions of it as may be presently owned by the Grantor) to modify, amend, and supplement the Original Grant in the manner set forth below: For valuable consideration, the receipt of which is acknowledged, and intending to be legally bound, it is agreed between the parties to the Right of Way Grant that i t is modified and amended as follows: Grantor grants, bargains, sells, warrants and conveys to Grantee, its successors and assigns, a right of way and perpetual easement on the same terms and conditions as are set forth in the Original Grant, all of which terms and conditions are incorporated into this Supplement, except that:(Additional Term(s) or Condition(s)) Except as modified and amended, the Original Grant is ratified and confirmed in all respects. This Supplement is dated _____. Grantor Grantee (Acknowledgments)