A ground rent agreement, made pursuant to this chapter, may be incorporated into the deed, ground lease, or other instrument of transfer in the following form:

This deed is subject to annual ground rent or charge as follows:

1. Date of agreement;
2. Parties:

Obligor ______________

Obligee ______________;

3. Ground rent and any future adjustments to it;
4. When payable;
5. Duration;
6. Redemption price, if agreed on.