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Dated this day of <br />ATTEST: <br />By: <br />Kareemah Fowler, City Clerk <br />STATE OF INDIANA } <br />} SS: <br />ST. JOSEPH COUNTY } <br />201 . <br />GRANTOR: <br />City of South Bend, Indiana, by and through its Board of <br />Public Works <br />By: <br />Pete Buttigieg, Mayor <br />Before me, the undersigned, a Notary Public for and in said County and State this day of <br />201_, personalty appeared Pete Buttigieg and Kareemah Fowler, to me known to be <br />the Mayor and City Clerk, respectively, of the City of South Bend, Indiana, the Grantor, and acknowledged <br />execution of the foregoing Quit Claim Deed. <br />IN WITNESS WHEREOF, I have hereunto subscribed my name and affixed my official seal. <br />(SEAL) <br />Resident of <br />Commission expires: <br />_, Notary Public <br />County, <br />I affirm, under the penalties for perjury, that I have taken reasonable care to redact each Social Security number in this document, <br />unless required bylaw. Benjamin J. Dougherty. <br />Prepared by Benjamin J. Dougherty, Assistant City Attorney, 1200 S. County -City Building, 227 W. Jefferson Blvd., South Bend, <br />Indiana 46601 <br />Page 2 of 2 <br />