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<br />11 220-05225
<br />kt�tQRVED AS PREsENTED ON
<br />8 1 6 3 7 3 -, aZl2sr2UZO 12;52 PK
<br />Tx:4101807 i4AR I SETH sw siren
<br />St. JOSEPH COUNMTIP
<br />RLCO laur
<br />Hold Recorded copy for: Board of Public Works ms" FEEI, a5 00
<br />CONSENT TO ANNEXATION, WAIVER OF RIGHT TO REMONSTRATE
<br />AND ACKNOWLEDGMENT OF MISCELLANOUS CITY FEES
<br />In con,idcratiORI 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 I -e 4/,v i
<br />Property Address
<br />Tax ID/Key
<br />Property Description
<br />Mailing Address /V '7
<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 whiell 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 Scull, 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 Full with tile 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 />Ifle OctivcrY of any instrument orcoaveyallce from the Owner to any SUCCCSSOT', grantee, vendee or contract Purchaser is subject
<br />to the terms ofthis 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 SUCCeisUrS in title.
<br />--- V& W14
<br />(Property Owner T Signature)
<br />be /,,'k I <, . A
<br />Property Owner (Print Name)
<br />WELA
<br />ante
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<br />Dale: --------
<br />BOARD OF PUBLIC WORKS APPROVAL
<br />Gary A. Gilwat, President
<br />` Men �bor
<br />Men
<br />ik aradik, M ber
<br />Date:
<br />STATE OF INDIANA
<br />) SS.
<br />COUNTY OF ST JOSEPH I
<br />Before me, a Notary Public in and for
<br />appeared bcwsaid County and myr 0 -dhc State, personally
<br />acknowledged the execution of the foregoing Consent to Annexation as his voluntary act and dead.
<br />INII SS my hall4 and Notarial An$ 2
<br />Day f_4!L._
<br />2
<br />A resident of
<br />(PIcAod N..,,,) MY Commission Expires:
<br />fol-itsual—I flul rlzwg qak,,r —'" bi
<br />K-rmv-
<br />ag I -mimimd-ky law
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<br />It e s2z Se
<br />V 1.8.19
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