The undersigned owner(s) of the property described as:________________________________________________

Detailed location of tree: ________________________________________________________________________________

County, Michigan, have requested that Alger Delta Cooperative Electric Association (the “Co-op”) cut/trim tree(s) at the location above to the extent that a qualified person can remove, the remainder of the tree(s) without damage to or interference with the Co-op’s facilities.

The owner(s) understand that the Co-op is willing to provide such forestry assistance, which in its sole judgment, is appropriate.

It is understood that the undersigned has the authority to grant this permission releases the Co-op and its agents from any liability arising out of the work performed.

The owner(s) agree that the Co-op will not be responsible for the disposal of brush, wood, or timber or for the restoration of the premises.

Date: ____________ 20____ Owner: ____________________

Witness: _______________________ Owner: ____________________

Mail to: ALGER DELTA COOP ELECTRIC –
426 NORTH 9TH STREET
GLADSTONE, MI 49837