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NWB - B/w FORti 8 4 lSED~ ~ 81-t1tr463~ ( IRES 3 R.U.W. ~ 0308 sxszBiT a -k~/ n PERMt7 N O R T H W E S T E R N B E L L T E L E P H O N E C O M P A~ } E X C H A N G E F A C I L I T Y E A S E M E N T F O R S E R V I N G -~ A R E A C O N N E C T O R A N D T E R M I N A L L O C A T I O N S The undersigned owns s) of an interest the real eat a described be (Hereinafter Celle 'Owner") hereby gr t(s) and cony (s) to NORTHWE RN SELL TELEPHONE COMPANY an Iowa Corporatio its associat and allied c aniea, its and their respec ive successors, as gna, lessees a d agents {Here after called, "Company"), in onsideration oft sum of Dollars ($ ) received f om the Company d of the ogre nts stated below, a ri t-of-^way and eas nt to conatruc operate, mai sin, replace and remove sac communications s terns as the Co any may from t e to time re airs. Said co nications systems shall consist o buried cable, onduit, manho es, surface erminals, protec ve barriers and associated equ ment which w 1 be instal ed, maintained, r inforced or remo ed as the Comp y may deem n cessary for a purpose of exe ising the right herein granted upon, under, across and thr gh a plot of lan feet wide nd feet to g, being a part o the following d cribed real a ate located the '. unty of State of re specifically described as: Signed this ~ day of ~4,~, ~•. , 14~. ~~ a WITNESSES: ~ OWNER: r n i pouse ACKNOWLEDGEMENT STATE OF NEBRASKA SS COUNTY OF HALL On this the -~~ r~ ~,ay of ~' «-~i "`~ 19~, before me, ..E~ r the undersigned officer, personally appears ~Inrri a n .~A Tar r oL ~ 7+., knows to ma ar satisfactorily proven to be the perean a whose name a subscribed to the within instrument and acknowladgsd that exectued the same for the purpose t w I_ ~~111t~{~ hereunto set my hand ayd,official seal. aT T[ M ,NA[•;N[[:R1K11 ~ f f 1 pre~f.~eN cxNt4 ~••~~,IN[T+cr...y'LG'. ~::-~C~- ~h ~~ H~ ~ Notary u lic MY co~isaian expires the /i-~~ day of _;~[t~-~<:-err 19 ~S~. i