AGREEMENT AS TO DAMAGES.
(Use form "Release of Damages" to the * then substitute to the next * as follows:) do hereby "agree to and with the said supervisors that the damages sustained by us by reason of laying out (or altering, or discontinuing) said road be ascertained and fixed, and the same are hereby ascertained and fixed as follows: (Describe the lands, give the owners' names, and the amounts agreed on;" and conclude as in form "Release of Damages.")