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AS TO LOT 200 <br />THE CITY OF SOUTH BEN%r t <br />DATED: By; <br />11 i <br />(Please print your name.a I �a this Iin e N oue.T <br />nt <br />STATE OF <br />SS. <br />COUNTY OF-. w , <br />Before me, Notary Public in and far sair County and�State In �. �.t q 20 <br />personally appeared °� : � ;� � "1: r Ate , the A�� �� �� �� u � ��,ao ��� rf T `E CITY OF SOUTH BEND <br />and acknowledged execution of the foregoing document for and on behalf of said Grantor, and who, having been <br />duly sworn, stated that the representations therein contained are true. <br />WITNESS my hand and Notarial Seal. <br />(SEAL) Notary Public, <br />C° n <br />My Commission Expir <br />LINDA MI MARTINI <br />Notary Public- Seal <br />State of Indiana <br />My Commission Expires Jun 28, 2020 <br />I affirm, under the penalties for perjury, that I have taken reasonable care to redact each social security number in this <br />document, unless required by law. Sylvia M. Durham <br />Prepared by: Sylvia M. Durham, Right of Way Agent, AEP — Indiana Michigan Power Company, 2929 W. Lathrop, South Bend, <br />IN 46628 Phone:574.283.1870 <br />