SAVANNA FIRE DEPARTMENT
101 MAIN STREET
SAVANNA, ILLINOIS 61074

PROPERTY RELEASE FORM
LIVE TRAINING EVOLUTIONS IN STRUCTURE

DATE

E-Mail Address: 		 
THE UNDERSIGNED having agreed with the Building Official of the City of Savanna, Illinois, that a
structure owned by me, the undersigned, and located at
,Savanna, Illinois, the legally described on "Appendix A" attached hereto and made a part of this document. Said structure is un-fit for human habitation and is beyond rehabilitation or is unfit for its intended use and is beyond rehabilitation and that said structure should be demolished.

In order that demolition may be accomplished I, the undersigned, herewith give my consent to the Savanna Fire Department to demolish by burning or other means, the said structure here in above described and located.

I, the undersigned, further agree that upon completion of said burning and demolition I shall cause the clean-up of said premises and fill or substantially barricade any excavation or cavity created by said demolition promptly at my expense.

I, the undersigned, further release the Savanna Fire Department from any claim for loss resulting from such demolition.
NAME/TITLE
ADDRESS
(STATE OF ILLINOIS)
(COUNTY OF CARROLL)
I, , a Notary Public in and for said County and
State, DO HEREBY CERTIFY THAT personally
known to me to be the same person whose name is subscribed to the foregoing instrument, appeared before me this day in person and acknowledged that signed, sealed and delivered the said instrument as a free and voluntary act, for the uses and
purposes therein set forth.
Given under my hand and notarial seal this day of A.D.

_______________________________________________________ Notary Public