I/we the undersigned property owners, for the consideration of $1 (payment waived), grant to the TOWN OF ULSTER the right to enter my/our property at the specified address to perform the following work in connection with the TOWN OF ULSTER Highway system:

The TOWN OF ULSTER may enter upon the property described above within

of the date of this consent, after which this consent shall automatically terminate.

The TOWN OF ULSTER will cause no unreasonable damage to the land during the work and will restore the land to substantially the same condition as it was before such work to the extent practical in keeping with the purpose of the work.

Signature: _________________________________     Date: ____/____/____