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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 />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 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 />(Property Owner l Signature,) <br />Property Owner (Print Name) <br />hate; <br />BOARD OF PUBLIC WORDS APPROVAL <br />4GA.Gtlo¢„°'residwtttt <br />('icttc'txic c E. Miller , ember <br />Elirabcth A Mdradik Member <br />r <br />Thcr se J lrarair, Member <br />Laura L. O'Sullivan, Member <br />Date: <br />l'/aZo/ <br />STATE OF INDIANA ) <br />) SS: <br />COUNTY OF ST JOSEPH ) <br />Before me, a Notary Public in and for said County and State, personally <br />appeared ._k and he acknowledged the execution of the foregoing Consent to <br />Annexation as his voluntary act and deed. <br />ESS tray hand andNotarial Seal is �.... .ww Day of "- dQow. <br />(Signature) <br />A resident of <br />(Printed Name) My Commission Expires: 9 Z>]t— % <br />ZG <br />ta�ctrrt(aa acicz'a i terd9�urw�tlftwrc S have„l a rr r� I lc try r b t azut eae 4cvc i ?� a y Ctu�n er irm thr. rtuuunt t_t <br />nWM <br />rtaw:Lthtldr!ltti�u8_ <br />