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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 1 <br />Property Address <br />Tax ID/Key # <br />Properly Description <br />Mailing Address <br />o- <br />�.OcDo -0 24l <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) 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 />BOARD OF PUBLIC WORKS <br />(Property Owner IgUstl e <br />Gary �%. Clot, President Therese J. Doran, Member <br />Property Owner (Pr'int. Name) <br />Elizabeth A. Maradik, Member <br />Jordan V. Gathers, Member <br />Y-� <br />ATTEST: <br />c,ff;o-'* <br />Joseph R. Molnar, Member <br />_ <br />Linda M. Martin, Clcrk <br />Dalc: 8 <br />Date: August 25, 2020 <br />STATE OFINDIANA ) <br />SS: <br />COUNTY OF ST JOSEPH ) <br />flefotc lu a 0 at, rr�lic in for said County and State, personally <br />a tcar`eal I I ��a and he acknowledged the execution of the foregoing Consent to <br />AA A <br />1�llTNl`SS�myhandtpnd �otarataSealI is Day of RA 2 s ttt � .A'$frr0+tt <br />00 <br />"* Iti7I rI. r <br />.. ► <br />�"""I' <br />,. <br />''�.: SATE <br />15, uru,rcp <br />A resident of <br />(Printed Name) My Commission Expires: <br />J' �u�ad..�s.p� .AV � �b^�sgl�t�t�.�.t1pSM�ur��a�lx.!IiuJatlizsnr.�N���aat�ludas.�!J� <br />V 1.8,19 <br />