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4 1 t <br />WAIVER OF STATUTORY TIME PERIOD FOR <br />ACTION BY THE <br />HISTORIC PRESERVATION COMMISSION <br />OF SOUTH BEND AND ST. JOSEPH COUNTY <br />WHEREAS, county and city ordinances require the Historic <br />Preservation Commission of South Bend and St. Joseph County to <br />act on my application for a certificate of appropriateness within <br />thirty (30) days after its filing; <br />WHEREAS, I have been informed that additional time is <br />needed to review my application because of insufficient, or <br />incomplete, information; <br />, the applicant for a certificate of <br />appropriateness for certain property located at <br />Indiana, do hereby consent <br />to an extension of the time to act on my application to and <br />including <br />Date: <br />APPLICANT <br />STATE OF INDIANA ) <br />SS: <br />COUNTY OF ST. JOSEPH ) <br />Personally appeared before me, a Notary Public in and for <br />said County and State, , the above-named <br />Applicant and acknowledged the execution of the above and <br />foregoing as her/his voluntary act and deed, on this day of <br />, 19 <br />Notary Public <br />My Commission Expires: <br />Resident of County, Indiana. <br />Received: Historic Preservation Commission of South Bend <br />and St. Joseph County this day of , 19 <br />Historic Preservation Commission <br />• <br />