5600-FM-BMP0031
10/2013
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF ENVIRONMENTAL PROTECTION
BUREAU OF MINING PROGRAMS
NOTICE OF PRIOR LEASES (NONCOAL)
I (We), the undersigned, being the lessee(s) of
acres of land located in
Township,
County, as described in the lease recorded in the
Recorder of Deeds Office at Book
on page
, and shown by crosshatched
lines on the map attached hereto which is signed in the original by the lessee(s) upon which (I) (we) propose to
engage in noncoal surface mining activities for which application for permit will be made to the Department of
Environmental Protection, and this Notice of Prior Leases is made part of the permit application, DO HEREBY
STATE AND CERTIFY (I) (WE) HAVE THE RIGHT TO ENTER UPON AND USE THE LAND FOR THE
PURPOSES OF CONDUCTING SURFACE MINING ACTIVITIES. Furthermore, notice is hereby given as provided
for in Section 7(c)(7) of the Noncoal Surface Mining Conservation and Reclamation Act, the Act of December 19,
1984 (52 P.S. §§3301-3326), that a Contractual Consent of Landowner Agreement covering this area is
unnecessary. Furthermore, (I) (We), the undersigned, do hereby irrevocably grant to the Commonwealth of
Pennsylvania, the right to enter upon the aforesaid land for purposes of inspecting, studying, backfilling, planting and
reclaiming the land and abating pollution in accordance with the provisions of the Noncoal Surface Mining
Conservation and Reclamation Act, The Clean Streams Law, and The Coal Refuse Disposal Act, as amended, rules
and regulations promulgated thereunder, and the provisions of permit(s) issued to the Mining Operator. (I) (We) do
hereby certify, where necessary, that the above grant of access includes the right to travel from a public right of way
across any contiguous or adjacent lands to the land described herein. It is specifically agreed and understood that
this grant of Right of Entry gives the Commonwealth the right to enter, inspect, study, backfill, plant and reclaim the
land and abate pollution therefrom as a matter within the police power but does not obligate the Commonwealth to do
so, and does not constitute any ownership interest by the Commonwealth in the aforesaid land.
This notice of Prior Leases and Grant of Right of Entry to the Commonwealth shall not be construed to impair any
contractual agreement between the Mine Operator and the landowner.
Describe the Chain of Title from the current lessee back to the next to the most recent owner of the land in fee
simple. If necessary, complete the Chain of Title on an attachment to this form.
A Certificate of Title and a copy of the lease providing for the Right of Entry (is) (was) submitted to the Department as
part of the permit application. The termination date of the lease is
.
In witness whereof and intending to legally bind (myself) (ourselves), (my) (our) heirs, successors and assigns, (I)
(we) have hereunto set (my) (our) hand(s) and seal this
day of
, 20 .
Permittee
By:
(Print Name)
(Print Name)
(Seal)
(Signature)
By:
(Signature)
-1-
5600-FM-BMP0031
10/2013
ACKNOWLEDGEMENT OF INDIVIDUALS OR PARTNERS
PERMITTEE
STATE OF
:
:
:
COUNTY OF
On
ss
, before me, the undersigned Notary, personally appeared
(Name (s))
known to me (or satisfactorily proven) to be the person whose name is subscribed to this instrument, and who acknowledged that
(he, she or they)
executed the same and desires it to be recorded.
IN WITNESS WHEREOF, I have hereunto set my hand and official seal.
(SEAL)
My Commission Expires:
Notary Public
(Date)
PERMITTEE
STATE OF
:
:
:
COUNTY OF
On
ss
, before me, the undersigned Notary, personally appeared
(Name (s))
known to me (or satisfactorily proven) to be the person whose name is subscribed to this instrument, and who acknowledged that
(he, she or they)
executed the same and desires it to be recorded.
IN WITNESS WHEREOF, I have hereunto set my hand and official seal.
(SEAL)
My Commission Expires:
Notary Public
(Date)
ACKNOWLEDGEMENT OF CORPORATIONS
PERMITTEE
STATE OF
:
:
:
COUNTY OF
On
ss
, before me, the undersigned Notary, personally appeared
,
who acknowledged (herself) (himself) to be the
of
(Title of Person)
,a
(Name of Corporation)
corporation, and that (she) (he), as such officer, being authorized to do so, executed the foregoing instrument on behalf of the said corporation and
desires that this instrument be recorded.
IN WITNESS WHEREOF, I have hereunder set my hand and official seal.
(SEAL)
My Commission Expires:
Notary Public
(Date)
This instrument has been recorded in
County, Pennsylvania, this
day of
,
(year), at Book
, Page(s)
(Signed) + (Print Name)
(Seal)
-2-
.