Notice is hereby provided of the existence of the
following lease:

1. LESSOR: _

2. LESSEE: _

3. LEASED PREMISES: _

4. TERM OF LEASE is _ years commencing on _, 19_
and ending on _, 19_.

5. OPTIONS TO EXTEND LEASE: _

6. OPTION TO ACQUIRE PROPERTY OR RIGHT OF FIRST REFUSAL: _

_______________________________
Lessor

_______________________________
Lessee

State of _
County of _ Date: _
Then personally appeared _
who acknowledged the foregoing, before me.

______________________________
(Notary Seal) Notary Public