Enter Your Name and Address:

Todays Date:

BY CERTIFIED MAIL,
RETURN RECEIPT REQUESTED

TO: Peter Marx, Pipeline Right of Way Manager
PennEast Pipeline Company, LLC
55 West Street
Tunkannock, 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., #2Co1
Wyomissing, PA 19610