This deed made the _________ day of _________[month], _________[year], between _________, of _________, grantor, and _________, of _________, grantee.

By a deed dated the _________ day of _________[month], _________[year], and recorded _________[state place, book, and page], between the parties, grantee did grant to grantor, his [her] heirs and assigns, _________[state the easement granted].

Grantor has agreed to relinquish _________[describe the easement] to grantee in consideration of _________ dollars.

In consideration of _________ dollars, paid by grantee to grantor, the receipt of which is acknowledged, grantor releases and forever quitclaims to grantee and his [her] heirs and assigns all the _________[state subject of easement] and his [her] rights thereunder, with the intent that _________ may be forever extinguished, and that grantee, his [her] heirs and assigns, shall have and enjoy the premises so granted, free and absolutely discharged from _________, and from all other easements belonging to grantor in the premises.

In witness, etc.