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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 />hi 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 n
<br />Property Address
<br />Tax ID1Key #
<br />Property Description
<br />Mailing Address ' Y
<br />1�"l�>�C KCh 'Kilt ✓ WATER ✓
<br />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 andrelease 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 LlSignature) B
<br />IryRh )lQrr1C,(Print Name)
<br />ndry,�naxec�CW^'
<br />BOARD OF PUBLIC WORKS APPROVAL
<br />Gary A. Gilot,", residerrt
<br />4 enevoev• 1=:, M1,11er • fiber
<br />1?li1abart�h A. Mu a �k, Mciriber
<br />i Thee �1. UomU,Sd•t,; r
<br />l,° ra I...(� f Sullivan. Mel her
<br />Date: j o t}
<br />STATE OFINDIANA )
<br />COUNTY OF ST JOSEPH ) SS:
<br />Before m a Notary 'ublic 't and for said County and State, appeared ...£ice' '�.rr'-r-�o. "..... personally
<br />-And he he acknowledged the execution of the foregoing Consent to
<br />Annexation as is voluntary act and dcct ,
<br />WITNESS inv hand and Nota R rm) ihis�,,,F� _ of�'
<br />11;K1 DaySte,
<br />ri A resident of, .
<br />" (Printed Name) L/0 -
<br />MyCommissionExpires: '� �'ar"
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