Fill and Sign the Uj O U U Ti O W U U New Jersey State Library Form

SURFACE USE AGREEMENT (Establishing Amounts Lessee will Pay for Road and Location Damages) State: County: Lessor: (Name and Address) Lessee: (Name and Address) Effective Date: On (Date of Lease), Lessor, named above, executed and delivered to Lessee, named above, an Oil and Gas Lease (the "Lease"), which is recorded in Volume ____, page ____, of the ____ Records of the county and state named above, on and covering the following lands (the "Lands") in that county: (Description of Lands Covered by the Lease) Lessee has agreed to pay and Lessor has agreed to accept the following as full paym ent for any and all damages, if any, that may occur in connection with Lessee's operations on the Lands under the terms of the Lease: 1. The sum of $____ for each drill site location. 2. The sum of $____ per rod for new roads constructed by Lessee. 3. For any accident resulting in the death of cattle caused by Lessee's operations, the market value, on the date of the accident, of the cattle killed. 4. Other items which Lessor and Lessee may agree upon by supplements to this Agreement. The agreed on amounts for damages, as set out above, are the total sums to be paid by Lessee to Lessor for any specified damages. Lessor agrees that the consideration recite d is adequate and the full payment for such damages. This Agreement is signed by Lessor and Lessee as of the date of acknowledgment of the parties signatures below, but is effective for all purposes as of the Effective Date stated above. Lessor Lessee