TOWN OF BOW, NEW HAMPSHIRE
Department of Highways
Flowage Release

KNOW ALL BY THESE PRESENTS, THAT, I, ................................................................................................., do hereby release to the said Town of Bow, New Hampshire the right to construct a ditch or lay a drainage pipe in the Town of Bow, New Hampshire at the following location: .............................................................................................

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AND I DO HEREBY ALSO RELEASE to the said Town the right to flow water through said ditch or pipe and empty the water upon my land together with the right to forever maintain the said ditch or pipe in repair and enter upon my land at any and all times for the purpose of cleaning out or repairing said ditch, providing however, that no damage to my land or crops is occasioned by these entries or repairs.

I HEREBY RELEASE the said Town of Bow, New Hampshire from any and all claims to damage arising from or incidental to the construction or the maintenance of the drainage referred to above with the exception as stated.

IN WITNESS WHEREOF ................. have here unto set ............ hands and seals this .............. day of ....................., 20...........

Signed, sealed and delivered
in the presence of:

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STATE OF NEW HAMPSHIRE,                    SS.                                                A.D., 20.......

Personally appeared the above-named .....................................................................................................................

and acknowledged the foregoing instrument to be .............................................................................. voluntary act and deed.  Before me:

                                                                              ......................................  Justice of the Peace.