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Hold Recorded copy for: Board of Public Works
<br />CONSENT TO ANNEXATION, WAIVER OF RIGHT TO REMONSTRATE
<br />AND ACKNOWLEDGMENT OF MISCELLANOUS CITY FEES
<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 I
<br />Property Address
<br />Tax ID/Key #
<br />Property Description
<br />Mailing Address
<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 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) ofthe 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 ofany 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 />..� �
<br />fl"topen), Owner I Siigny�ire)
<br />N,J
<br />Property Owner(I'lilk•
<br />tt nntC)
<br />BOARD OF PUBLIC WORKS
<br />Gary A Gilot, President_
<br />• vV�
<br />Elizabeth A. Maradik, Member
<br />Joseph R. Molnar, Member
<br />Date; _ AU Ust 25 2020
<br />Therese J. Doran, Member
<br />Jordan V. Gathers, Member
<br />ATTEST:
<br />ter,,: i cf �avw
<br />Linda M. Martin, Clerk
<br />STATE OF INDIAN,"s t
<br />) SS;
<br />COUNTY OFSTJOSEPH I
<br />Before ruse It hurl ay Public in and for said County and 'Slut I:icls ta, T wANtf
<br />appeared .NC i1 � �� i�_ and he acknowledged the execution of the l'orul,rmngr 0rlscftn to
<br />LACLUVE
<br />Annexation as biw voluntary act and deed. NoSeal
<br />�aty Public - State of Indiana
<br />'w I I SS uny hand abut Notan ial Seal this Day of � " 20 1
<br />- RJoerph County
<br />(Signature)
<br />Mytxomellfae6orl I«x ia•ee Dec 3, 2013
<br />ry
<br />V Aresident of �1 V ]r �q
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<br />(Printed Name) My Commission Expires:
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