I, _______________ (Clerk and Recorder), of Flathead County, Montana, do certify that the following order was made by the city council of Columbia Falls at a meeting thereof held on the _____ day of __________, 19_____, and entered into the proceedings of said Body to-wit: "Inasmuch as the dedication of park land within the platted area of _______________ (Name of Subdivision) is undesirable for the reasons set forth in the minutes of this meeting, it is hereby ordered by the city council of Columbia Falls that land dedication for park purposes be waived and cash in lieu of park land in the amount of __________ dollars ($_____) be accepted in accordance with the provisions of 76-3-606, M.C.A."

In witness whereof, I have hereunto affixed the seal of Flathead County, Montana this _____ day of __________, 19_____.

(Seal)

_________________________

(Signature of Clerk)