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OUR LADY OF THE ROAD INCORPORATED <br />By: _______________________________ <br />Printed: ___________________________ <br />Title: _____________________________ <br />State of Indiana ) <br />) SS: <br />County of St. Joseph ) <br />This instrument was acknowledged before me on this ______ day of _________________, <br />2021 by ______________________, known to me to be the _______________ of Our <br />Lady of the Road Incorporated. <br />_________________________ <br />Notary Public <br />Print Name:________________ <br />My Commission Expires:___________ <br />I am a resident of ______ County, ______ <br />Acting in the County of ___________, ____ (State) <br />I affirm, under penalties for perjury, that I have taken reasonable care to redact each Social <br />Security number in this document, unless required by law. /s/ Sandra L. Kennedy <br />This instrument prepared by Sandra L. Kennedy, Corporation Counsel, City of South Bend, <br />Indiana, Department of Law, 227 W. Jefferson Blvd., Suite 1200S, South Bend, IN 46601. <br />When recorded hold for pick up by: City of South Bend, Indiana, Board of Public Works.