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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"), sat fated ira t 9oseph County, Indiana,
<br />Property Owner l "fto A �s a l' ("f/,) A°/)
<br />Property Address
<br />Tax ID/Key #
<br />Property Description
<br />Mailing Address
<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 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 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
<br />acknowledges and accepts the Owner's obligation to pay a wastewater and water system development charge based
<br />on expected usage. Further, the Owner acknowledges and agrees to pay the applicable surcharge established under
<br />Chapter 17, Article 10, Section 17-81 for wastewater service.
<br />The delivery of any instrument of conveyance from the Owner to all successaar, grantee, vendee or contract purchaser is subject
<br />to the terms of this document and the acceptance of such i nstrum it shall constitute an acceptance of the foregoing provisions
<br />by said grant ^, vendee, or contract purchaser and t icces.�rs in title.
<br />1) A111PUBL, IC WORKS AP111401r
<br />......W_._ _
<br />W Owtaes ignatore;) Gary A. Odot" President
<br />Owner (Print Name) t C� rtm vsa'. E. Miller, M aptlaar
<br />1 P Irm ga la A. ' arada9 „ Mernbct
<br />h=escJ Doram, M nrlia¢rl�
<br />Laura L. O'Sullivan, Member -
<br />e
<br />Date' 26, t Date: / Z 1�1Z n (
<br />STATE OF INDIANA
<br />) SS:
<br />COUNTY OF ST JOSEPH )
<br />Before n e. a Notary Public in and for said County and State, personally
<br />aappmuvl �j 4 1 Ca -11 O _ _ and he acknowledged the execution of the foregoing Consent to
<br />Annexation as his voluntary act and deed, r
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<br />eatl this-_ � _ Day t + 2 1"'1" �S n Itarul and aatauaq � -�
<br />(Signatu )
<br />MeNk/kak h � 1- r apt
<br />A resident of n
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<br />(Printed Name) My Commission Expires: )
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