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Annexation Application Checklist <br /> 0 1. Completed Application Form <br /> El 2. Site Plan (drawn to scale) <br /> ❑ 3. Subdivision Application (if required) <br /> 4. Criteria for Decision Making (if required) <br /> 0 5. Filing Fee <br /> Contact Information <br /> Name: Danch, Harner & Associates, Inc. Attn: Michael Danch/Matthew Kirkwood <br /> Address: 1643 Commerce Drive, South Bend, IN 46628 <br /> Phone Number: <br /> 574-234-4003 Email: mdanch@danchharner.com,mjkirkwood@ danchharner.com <br /> Property Owner Information (attach additional ownership list on separate page.if necessary) <br /> Property Owner: Trematerra Family Land Holdings Inc. <br /> Property Owner Address: 6231 Pga Blvd., Suite 104-227, Palm Beach Gardens, FL 33418-4033 <br /> Property Owner: <br /> Property Owner Address: <br /> By signing this petition,the Petitioner/Property Owner(s)of the above described Real Estate acknowledge(s)they <br /> are responcible for understanding and complying with the South Bend Zoning Ordinance and any other ordinance <br /> governing the property.Failure of staff to notify the petitioner of a requirement does not imply approval or waiver <br /> from anything contained within the ordinance. <br /> The undersigned authorizes the contact person listed above to represent this petition before the South Bend Plan <br /> Commission and Common Council and to answer any and all questions related to this petition. <br /> Property Owner Signature Property Owner Name Printed Date <br /> Property Owner Signature Property Owner Name Printed Date <br /> Completed applications should be submitted in one of the following <br /> ways: Email: zoning®southbendin.gov <br /> Mail: 227 W. Jefferson Blvd., Suite 1400S, South Bend, IN 46601 <br /> Page 2 of 2 <br />