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<br />Hold Recorded copy for: Board of Public Works Sr, JOSEPH COUNTY
<br />CONSENT TO ANNEXATION, WAIVER OF RIGHT TO REMONSTRATE RECORDER
<br />AND ACKNOWLEDGMENT OF MISCELLANOUS CITY FEES PGSn 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
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<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 ofthe 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 acknowledges
<br />and accepts the Owner's obligation to pay a wastewater and water system development charge based on expected usage.
<br />Further, the Owner acknowledges and agrees to pay the applicable surcharge established under Chapter 17, Article 10,
<br />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 />tProperty �twtuer li , t, rare)
<br />Property Owner (Print Name)
<br />BOARD OF PUBLIC WORKS
<br />APPROVAL
<br />Gary A, Gilot, President
<br />Jaarrlat V" alltmafs, tv6+:m
<br />t. h�wire9 a A. atrasii , CsA'epti er
<br />Therese J. Dorau, Member
<br />Joseph R. Molnar, Member
<br />Date:. Date: .. v oZ L
<br />STATE OF INDIANA )
<br />SS:
<br />COUNTY OF ST JOSEPH )
<br />Before me, a Notary Public in and for said County and State, personally
<br />appearedand he acknowledged the execution of the foregoing Consent to
<br />Annexation as his voluntary act and deed`�} 1,,,
<br />this if ff 1. Day of �1 20, 1O
<br />'I NI;,"'� my hand and otaxiat Seal this
<br />.., Ail
<br />trm �' ttbrw.p t
<br />"%WICK
<br />Aresident of L"
<br />(Printed Name) My Commission Expires: t
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