Enter Your Name and Address:

Today’s Date:

BY CERTIFIED MAIL,RETURN RECEIPT REQUESTED

TO: Peter Marx, Pipeline Right of Way ManagerPennEast Pipeline Company, LLC55 West StreetTunkannock, PA 18657-1455

Re: Denying Property Access for PennEast Pipeline Project

Dear Sir/Madam:

As the owner of the property located at:

Lot # _______________, Block # ___________________ Township of:_______________

County of _____________________, In the State of___________________________

I hereby REFUSE PERMISSION to the PennEast Pipeline Company, LLC., as well as any of its representatives, contractors, sub-contractors, affiliates or associates to enter my land for any purpose, including but not limited to performing surveys or other investigations. Any physical entry onto my property from the date of this letter forward will be considered unauthorized, and treated as trespassing.

Sincerely,

__________________________________Signature

__________________________________Printed Name

Cc: UGI Energy Services, Inc.1 Meridian Blvd., #2Co1Wyomissing, PA 19610