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<br />2 <br /> <br /> <br />Please provide a copy (not original) of the recorded deed that indicates the applicant is the property owner. If <br />you do not have a copy of the recorded deed, one is available through the St. Joseph County Recorder, located <br />on the 3rd floor of the County-City Building, 227 W. Jefferson Blvd., in downtown South Bend. For questions, <br />the St. Joseph County Recorder can be reached at (574) 235-9525. <br /> <br /> <br />APPLICANT’S CERTIFICATION AND AUTHORIZATION <br /> <br />1. I/We understand that by submitting a donation form we are requesting the City of South Bend accept <br />my/our property at no cost to the City. <br /> <br />2. I/We understand that the City of South Bend has the right to accept or not accept the donation of a <br />property based on its internal review of the property in question. <br /> <br />3. I/We understand that the City of South Bend cannot provide a tax deduction letter for the donation of a <br />property. <br /> <br />4. I/We understand and agree that the City of South Bend will need to secure and verify documents <br />supporting my/our request for donation. <br /> <br />5. I/We agree to supply the City of South Bend with all information requested and give them authorization <br />to verify all information contained in my/our application or any other documents required in connection <br />with this program. <br /> <br />6. I/We agree that should the City not have interest in accepting the donation of my/our property, the City <br />may share provided information with other entities which may have interest in the donation. In these <br />instances, the other entity and I/we would be responsible for reaching an agreement related to the <br />transfer of property. <br /> <br />7. I/We agree that this information may be reproduced or photocopied and a copy shall be effective consent <br />as the original signed form. <br /> <br />All property owners listed on the deed must sign below.* <br /> <br /> <br />_________________________________________ _______________________ <br />Owner of Record / Donor Signature Date <br /> <br /> <br />_________________________________________ _______________________ <br />Owner of Record / Donor Signature Date <br /> <br /> <br /> <br />* If the owner of record is deceased, the person(s) and/or entity with the legal authority to donate may sign the donation form, but <br />must provide documentation of authority to sign on behalf of the deceased.