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Hold Recorded copy for: Board of Public Works <br />CONSENT TO ANNEXATION, WAIVER OF RIGHT TO REMONSTRATE <br />AND ACKNOWLEDGMENT OF MISCELLANOUS CITY FEES <br />In consideration for permission to tap into the municipal utility system (water and/or sewer) of the city of South Bend, <br />Indiana, in order to provide sanitary sewer and/or water service to the following described property, (hereinafter referred <br />to as the "Real Estate"), situated in St. Joseph County, Indiana. <br />Property Owner 1 <br />Property Address <br />Tax ID/Key # <br />Property Description <br />Mailing Address <br />Pat and Jill Walsh <br />18413 Forest Glade Dr., South Bend, IN <br />002-1014-0300 <br />Lot 81 Bradford Shores at Knollwood Sec 3 17/18NP#4636 11/17/2016 <br />P.O. Box 619 Granger, IN 46530 <br />✓ WATER Ll SEWER <br />owner(s) of the Real Estate, (hereinafter "Owner"), for themselves and their successors in title, assigns, and personal <br />representatives, hereby irrevocably waive and release any and all right which they may now or hereafter have to remonstrate <br />against or otherwise interfere with, or oppose any pending or future annexation ofthe Real Estate by the City of South Bend. <br />In further consideration and to induce the City of South Bend to allow Owner to tap into the municipal utilities (sewer and/or <br />water) of the City of South Bend, Owner, for themselves and their successors and assigns, agrees and stipulates irrevocably to <br />vest in the City of South Bend the permanent right, at the City's discretion, to annex the Real Estate at any future time by duly <br />authorized ordinance. <br />Owner further agrees that any deeds, contracts, or other instruments of conveyance made by Owner, their successors or assigns <br />shall contain the waiver and release provisions contained herein, which provisions shall run with the land. <br />Pursuant to Chapter 17, Article 10, Sections 17-79 and 17-80 of the South Bend Municipal Code, Owner acknowledges and <br />accepts the Owner's obligation to pay a wastewater and water system development charge based on expected usage. Further, <br />the Owner acknowledges and agrees to pay the applicable surcharge established under Chapter 17, Article 10, Section 17-81 <br />for wastewater service. <br />The delivery of any instrument of conveyance from the Owner to any successor, grantee, vendee or contract purchaser is subject <br />to the terms of this document and the acceptance of such instrument shall constitute an acceptance of the foregoing provisions <br />by said grantee, vendee, or contract purchaser and their successors in title. <br />c�� <br />(Property Owner ]Signature) <br />Property Owuer (Prirrt Name) <br />z <br />0 <br />ors <br />4'1z-wz o <br />v <br />N ry Z W ra <br />,p Nrvi W V4 <br />Date: <br />A ,s4 <br />V ^� <br />W <br />STATE TF INDIANA ) <br />) SS: <br />COUNTY OFSTJOSEPH ) <br />Before me, a Notary Public in <br />appeared <br />Annexation as his voluntary act and deed. p <br />OF PUBLIC -WORKS <br />Gary <br />James A. Mueller, Member <br />Date: < 7 <br />and for said County and State, perst <br />and he acknowledged the execution of the foregoing Consent to <br />WITNESS m ha d and A otanal Seal his Day of UU <br />(Signature). <br />�vay A resident of <br />(Printed Name) <br />My Commission Expires: <br />2017. <br />I affirm, under the penalties for periurv, that t have taken reasonable care to redact each Social Security number in this document unless required by law: <br />This instrument was prepared by Aladean DeRose City Attomey 1200 County -City Buildine South Bend. Indiana 46601. <br />t,'YrWWDffMn <br />NftYAubft <br />UAL <br />& oemow I <br />