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a political subdivision of the State of Minnesota <br />By: <br />Name: <br />Title: <br />Dated: , 20 <br />STATE OF MINNESOTA ) <br />) ss: <br />COUNTY OF ) <br />The foregoing instrument was acknowledged before me this <br />, by , the of <br />subdivision of the State of Minnesota. <br />This instrument was drafted by: <br />Ken Holman <br />Community Forest Program Coordinator <br />Minnesota Department of Natural Resources <br />Division of Forestry <br />500 Lafayette Road <br />St. Paul, MN 55155- 4044 <br />Notary Public <br />day of <br />, a political <br />18 <br />