The format for the notarized statement described in subdivision two of section 9-1907 of this title shall be as follows: NOTARIZED STATEMENT RELATING TO THE SETTLEMENT OF COMPETING CLAIMS OF TITLE TOWNSHIP FORTY, TOTTEN AND CROSSFIELD PURCHASE TOWN OF LONG LAKE, COUNTY OF HAMILTON Name(s): Mailing address(es): Telephone number(s): Tax parcel number: Circle either 1 or 2; if you circle 1, you must also circle a or b:

1. I (we) elect to participate in the process to resolve title issues regarding the above-referenced parcel as authorized by title nineteen of article nine of the environmental conservation law.

a. I (we) intend to reduce my (our) payment by gifting to the state a specified portion of a disputed parcel in fee simple without reservation for inclusion in the forest preserve or a conservation easement to the town restricting development over all or a specified portion of a disputed parcel, with a secondary right of enforcement in the state. The intended gift is described in the attached document.

b. I (we) do not intend to reduce my (our) payment to the state by gifting any portion of the parcel to the state or by gifting a conservation easement over any portion of the parcel to the town; or

2. I (we) elect to not participate in the special process to resolve title issues regarding the above-referenced parcel as authorized by title nineteen of article nine of the environmental conservation law. I (we) understand that: within twenty-four months of my (our) filing of this notice, the attorney general shall commence an action in a court of competent jurisdiction to determine title to such parcel; nothing in title nineteen of article nine of the environmental conservation law shall be applicable to such litigation; and failure by the attorney general to commence such action within such twenty-four month time frame shall not subsequently prevent the attorney general from commencing such an action or create a presumption against the state's claim of title. Signature (Notarization)