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<br />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 />Ea 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 Ray Herring and Karrah Miller
<br />Property Address 21520 Rivendell Ct., South Bend, IN
<br />Tax ID/Key # 004-1007-009014
<br />Property Description Lot 8 Whippoorwill Valley South See 1 & 2 1 st Corrective 02-03 New Repiat Tr 12858 2-28-02
<br />Mailing Address 21520 Rivendell Ct., South Bend, IN
<br />WATER LJ SEWER
<br />owner(s) of the Real Estate, (hereinafter "Owner"), for themselves and their successors in title, assigns, and personal
<br />hereafter
<br />representatives, hereby irrevocably waive and release any and all right which they may now or have to remonstrate
<br />against or otherwise interfere with, or oppose any pending or future annexation of the 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 Citys 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 />BOARD OF PUBLIC WORKS
<br />rr (Property Owner 1 Signature)
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<br />Property Owner (Print Name)
<br />Therese J. Dorau, M er
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<br />L1 Z c G N
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<br />N h N O
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<br />M a' M
<br />g GMark Berta, Notary Public
<br />STATE OF INDIANA ) Comm" Expires May 14, 2023
<br />) SS:Resides in St. Joseph Co., IN
<br />COUNTY OF STJOSEPH )Comm. Number 667909
<br />Before me, a 'Votary Public in and for said County and State, personally
<br />appeared , ,Lr% and he acknowledged the execution of the foregoing Consent to
<br />Annexation as his voluntary act and deed:
<br />R'I myband oum Sea is Day of, 2017.
<br />�� /j/(Sigrram
<br />A resident ofGS
<br />(Printed Name) My Commission Expires:
<br />James A. Mueller, Member
<br />Date: 3l -2 -L C
<br />I affirm. under the penalties for perjury, that I have taken reasonable care to redact each Smial Security number in this document unless Muimd by law:
<br />Jbie instrurnent v Aladcan DoRese, City AttornMoun " <B ildin -Sou Iran 46601. _ --
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