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The signature(s) of all property owner(s), or Attorney for all property owner(s) <br />K L <br />Signed: Q~ Signed: <br />Address: 23977 Brick Road Address: <br />South Bend, IN 46628 <br />Phone Number: 574 - 272 - 9205 Phone Number: <br />Name, Address & Phone Number of Contact Person/Preparer (Please print): <br />Doug Daugherty <br />23977 Brick Road <br />South Bend, IN 46628 <br />Tel. 574- 272-9205 <br />Baer-;;~ ?n ~~~r4~'s Office <br />rj VAN ~} L°~~ <br />