Fill and Sign the Release for Diverting Water in Favor of Governmental Agency Form

Release for Diverting Water in Favor of Governmental Agency Release executed on __________________ (date) , by _______________________ (name) of ______________________________________________ (street address, city, county, state, zip code) herein referred to as Releasor, in favor of ___________________________________ (name of governmental agency) whose local office is located at _________________________ _____________________________ (street address, city, county, state, zip code) herein referred to as Releasee. Whereas, according to a plan of _____________________________ (e.g., conservation operations) on file at _____________________________ (name of governmental agency) for the ____________________ (e.g., City or County) of ________________________ (State) the _____________________________ (name of governmental agency __________________________________________________________ ) (e.g., now operates or is about to construct or is about to put into operation) ( e.g., erosion control measures) which is _____________________________ (diverting or will divert) water _________ (to or from) land located at __________________________________________________________ (street address, city, county, state ), where ________________________________________________ (e.g., water does not normally flow thereon). Whereas, the above - described _____________________________ ( e.g., erosion control measures ) will affect the following described property owned by Releasor: ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ (set forth legal description) Whereas, the effect of _____________________________ ( e.g., erosion control measures ) on the property will be _____________________________________________ __________________________________________________________ (describe effect). 1. Now, therefore, In consideration of the sum of ___________________________ Dollars ($_______), receipt of which is hereby acknowledged, and in further consideration of _____________________________ ( e.g., erosion control measures ) now in operation or about to be constructed or put into operation, Releasor hereby releases and discharges said _____________________________ (name of governmental agency) and all persons and parties connected in any way with such construction, operation and maintenance thereof from any and all present and future claims and demands of Releasor against Releasee in connection with the said construction, maintenance or lack of maintenance thereof. 2. Parties Bound This release is limited to the operations set forth on the above plan and shall be forever binding on Releasor, Releasor = s heirs, executors, administrators and assigns. In witness whereof, the Releasor has executed this Agreement as of the day and date first above stated. ________________________________ Releasor 1 STATE OF ______________________ COUNTY OF _____________________ Personally appeared before me, the undersigned authority-at-law in and for the jurisdiction aforesaid, within my jurisdiction, the within-named _____________________________, who acknowledged to me that he signed, executed and delivered the above and foregoing Release on the day and date therein stated. ______________________________________ NOTARY PUBLIC My Commission Expires: 1 Form of acknowledgment may vary by state.