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2 <br />The signature(s) of all property owner(s), or Attorney for all property owner(s) <br />Signed: <br />Signed: <br />Address: 52423 Portage Road South Bend Indiana 46628 <br />Phone Number: {574) 273-4551 <br />Name, Address and Phone Number of Contact PersonlPreparer (Please print): <br />Danch, Harner & Associates, Inc. <br />2422 Viridian Drive, Suite 201 <br />South Bend, Indiana 46b28 <br />(574)234-4003 <br />~~~~ r~ ~r~~~°~ ~~~ <br />~~1 ~ ~ zoos <br />~~. ~~ <br />env . ~. E~°~, t3y. <br />