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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 l
<br />Property Address
<br />Tax ID/Key #
<br />Property Description
<br />Mailing Address
<br />WATER ✓ 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 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.
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<br />Property Owner (Print Name)
<br />BOARD OF PUBLIC WORKS At'Iw!ROVAI
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<br />Date:, ? i a LQ f
<br />....... ..................
<br />STATE OF 1NDIANA )
<br />SS;
<br />COUNTY OF ST JOSEPH )
<br />Nt 1Public in and for said uallly
<br />app Annexation �s hls �1rdr�t;u'w act and � a�crl xecution�lf IE diwtu Gly t a �aNyotar
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<br />a eare and heaoknowled edthee all iLle, Sl ,o of Indana I
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<br />A resident of it
<br />(Priuled Name) My Commission Expires t * t
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<br />V 1.8.19
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