THIS CONVEYANCE made the ________ day of __________
BETWEEN
_________________________________________________ (insert the name of
Owner, address, etc.) (hereinafter called the Owner) of the ONE PART
AND
_______________________________________________ (insert the name of Local
Authority) (hereinafter called the Local Authority) the wife of the assignor (or as the
case may be) of the OTHER PART.

WHEREAS the Owner is desirous of conveying by way of gift to the Local Authority
the premises hereinafter described for the perpetual use thereof by the public for
exercise and recreation and the Local Authority pursuant to every power enabling
them have agreed to accept the same upon the trust and for the purposes aforesaid.
NOW THIS DEED WITNESSETH as follows:
1. In pursuance of the said desire and agreement the Owner hereby conveys unto
the Local Authority ALL THAT (parcels) except and reserving as hereinafter
mentioned TO HOLD the same unto the Local Authority absolutely and for
ever.
2. There are excepted unto the said Owner out of the premises hereby conveyed
the free passage and running of water and soil from lands and houses adjoining
or near to the premises hereby conveyed and now vested in the Owner and also
the right at any time hereafter to carry under the said premises any sewer drain
channel or water pipe for the service of any lands or buildings adjoining or near
to the said premises and now vested in the Owner and also the right to carry
under the said premises such service as aforesaid, installation of any appliance
for the transmission of power, heat, light, sound or electricity or other work of
a like nature with full power for the owner and his successors in title. Owner or
Owners for the time being of the lands and houses adjoining the premises
hereby conveyed to enter upon the said premises for the purpose of making
laying and repairing or relaying any such sewer drain channel water pipe or
other work as aforesaid (he and they making good the surface of the said
premises at his and their own expense to the reasonable satisfaction of the
Local Authority or their successors).

3. The Local Authority hereby declare that they will hold the said premises
hereby conveyed following, namely, upon trust for the perpetual use thereof by
the public for the purposes of exercise and recreation.
4. The Owner hereby acknowledges the right of the Local Authority to production
of the documents of title specified in the schedule hreto which are retained by
him and to delivery of copies thereof (and hereby undertakes for the safe
custody thereof).

IN WITNESS WHEREOF etc.

SCHEDULE

[Signature of Owner and Seal of Local Authority]