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Adjacent Property <br />Owner(s) of Reco1 <br />Interest Owned: <br />Street Address: <br />Tax Id. Number(s; <br />Record No. of <br />Applicant's Deed: <br />Owner's Deed <br />Recording Date: <br />I am the owner of <br />Easement Agreem <br />DATE: <br />EXHIBIT C -3 <br />Description of Adjacent Owner and Adjacent Property <br />Andrew and Jon Kara Shields <br />Fee Simple <br />1017 California Avenue, South Bend, IN 46616 <br />is 018 - 1085 -3610 <br />Doc. No. i4il l 3 )-7 or Deed Book Page <br />off- <br />property interest specified above. I have reviewed this Cross Access <br />and am duly authorized to approve and execute it. <br />0l / 23 <br />ADJ FNT OWNER <br />By: <br />Printed Name: f nd w Shields ` r <br />Jo Kara Shields <br />STATE OF IANA ) <br />)SS: <br />COUNTY OF ST. JOSEPH ) <br />Before me, the undersigned Notary Public in and for said County and State, personally <br />appearedALvtrew T6 nio me to be the Applicant specified above and acknowledged <br />the execution oft e foregoing Agreement. <br />IN WITNESS WHEREOF, I have <br />seal on this g3 I day of January, 2016. <br />p��� J <br />MIE R. MILLER <br />�%I <br />.� �,. ; Notor <br />;NOTARY ; <br />Public, State of Indiana <br />Elkhart County <br />�* = C <br />mmission #t 670197 <br />- .SEAS , = <br />:-- t4), <br />Gommisslon Expires <br />July 09, 2023 <br />ibed my name and affixed my official <br />, Notary Public <br />Residing in e JkJ QL,r -1 , Indiana <br />