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REECORD D0AS Q� 45D ON
<br />1 6 2 1 V 7 02/11/2020 03:06 PM
<br />V x ; 4100 l0/4 MARY BETH wrsNrEwsKI
<br />Hold Recorded copy for: Board of Public Works ST. JOSEPH COUNTY
<br />CONSENT TO ANNEXATION, WAIVER OF RIGHT TO REM QNSTRATF RECORDER
<br />PC
<br />AND ACKNOWLEDGMENT OF MISCELLANOUS CITY FEES s: 1 FEES: 25.00
<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 Chc City of South Bend the permanent right, at the City"s discretion, to annex the Deal. 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 tun 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 ofany instrument of convcyance from the Owner to any successor, grantee, vendee or contract purchaser is subject
<br />to the teems 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 to title.
<br />(Property Owner, 1 Siiggnaa re)
<br />Property Owner (Print Name)
<br />Linda Thompson
<br />Notary Public, State of Indiana
<br />SEAL
<br />Reg. No. NP0717112
<br />Commission Expires 11/20/2026
<br />Date:, JANUARY 23, 2020
<br />STATE OF INDIANA )
<br />) SS:
<br />BOARD OF PUBLIC WORKS APPROVAL
<br />Gary 019-t'lbresident
<br />Jordan (,q1b,rs, /++lean r
<br />E 17abe111, aradik, , c hcrr
<br />1"ttca°eselDnu e r
<br />Jnveph Mohtar„ Member —
<br />Date: 21't
<br />COUNTY OF ST JOSEPH )
<br />Before me a Notary Public in and for said County and State, personally
<br />appeared_ ALD W WHEELER
<br />A 'adore as It v I � and he acknowledged the execution of the foregoing Consent to
<br />ON
<br />..�. voluntary act and deed.
<br />I1:'N S ' hand ttS of:rr%al Seal rss 23RD Day ofJANUARY 2020.
<br />(Signature)
<br />LINDA
<br />Aresident of ST. JOSEPH COUNTY
<br />(Printed Name) My Commission Expires: Nt)StFifittT2 7(1 202b
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