1 Olde Half Day Road, Lincolnshire, IL 60069 www.lincolnshireil.gov P: 847-883-8600 F: 847-883-8608
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STAMP HERE
EASEMENT STATEMENT
Legal Description (Fill-in below or attached legible copy to this form
EASEMENT STIPULATIONS & COVENANTS
Please be advised that the undersigned constitute all the owner(s) or record of the above described real
estate with the full right to sign this Easement Statement and bind said real estate, and that I/we fully
understand and acknowledge the following stipulations and covenants as they pertain to our installation
of a ____________________________ over, above, upon, on and in the Village of Lincolnshire’s
easement located on said real estate:
1. That _________________________ will be constructed on a Village of Lincolnshire easement.
2. That the Village of Lincolnshire will not be liable for any damage whatsoever to
__________________ that may result from the Village of Lincolnshire using, accessing, and/or
maintaining its easement.
3. That the Mayor and Board of Trustees of the Village of Lincolnshire, at their sole discretion, may,
at any time, require that the ______________________ be completely removed from its
easement at the sole expense of the owners of the fore described real estate.
4. That the stipulations set forth in Items 1 through 3, inclusive, above shall be binding upon the
undersigned, their heirs, executors, administrators, assigns and any successor in interest of
them or any party obtaining any right, title or interest in the above described real estate. These
covenants are intended for the benefit of the Village of Lincolnshire and may be enforced by the
Village of Lincolnshire by an appropriate action in law or equity.
________________________________
_________________________________
Subscribed and Sworn to me before this
_________ day of _______________, 20__
_____________________________________
Notary Public
State of
_______________
County of
_______________
Notary Seal
