Capital Improvement Acknowledgement Example [PDF]

Example -- Capital Improvement Ownership Acknowledgement – Example

I,

, as landowner, agree that the Capital Improvement described as (name)

, that is proposed to be installed by

on land

(bridge, culvert, etc.)

(name of installer)

owned by me, described as located on the

, in the (waterbody name)

1/4 of the

1/4 of Section

(N), Range

(E, W), Town of

, (Town name)

, Township

County, is owned by (County name)

County.

(Landowner or Representative)

(Representative of the County)

cc:

(Date)

(Date)