Fill and Sign the That Referred to below as Grantorwhether One or More for Good and Valuable Form

1 UTILITY EASEMENT (Collection System) STATE OF TEXAS § §COUNTY OF §That (referred to below as “Grantor”whether one or more) for good and valuable consideration paid by (the “Authority”), does hereby grant to the Authority an easement and right-of-way for the purpose of constructing, reconstructing and perpetually maintaining a sanitary sewer lift station and associated lines, equipment and electrical lines and structures (the “Facilities”) over and across the lands of Grantor, lying and being situated in County, Texas, being more particularly described as follows, to-wit: Together with the right of ingress and egress over Grantor’s adjacent lands to or from said right-of-way for the purpose of constructing, improving, reconstructing, repairing, inspecting, maintaining and removing said Facilities; the right to remove all trees within the easement; the right to relocate said Facilities in the same relative position to any adjacent road, if it is widened in the future; the right to prevent possible interference with the operation of the Facilities and to remove possible hazard thereto; and the right to prevent the construction within the easement of any building, structure or other obstructions, including the planting of trees, which may endanger or interfere with the efficiency, safety and convenient operation of the Facilities and its appurtenances. If such buildings, structures or other obstructions are constructed without written consent of the Authority, the Authority shall have the right to remove them from the easement.This agreement, together with other provisions of this grant shall constitute a covenant running with the land for the benefit of the Grantor, his successors and assigns.The consideration recited above shall constitute payment in full for all damages sustained by Grantor by reason of the installation of the Facilities.TO HAVE AND TO HOLD the above described easement and rights unto the said Grantor, his successors and assigns, forever. And Grantor does hereby bind himself, his heirs and legal representatives, to Warrant and Forever Defend all and singular the above described easement and rights unto the Grantor, his successors and assigns, against every person whomsoever lawfully claiming or to claim the same or any part thereof. EXECUTED this day of , 20 . Signature 2STATE OF TEXAS §§COUNTY OF §This instrument was acknowledged before me on the day of , 20