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Owner hereby attests to the accuracy of the statements in this document and all <br />attachments. <br />ACKNOWLEDGMENT BY A NOTARY <br />IN WITNESS WHEREOF, the Civil City of South Bend the said Owner of the Real Estate <br />described above has caused this Environmental Restrictive Covenant to be executed on <br />this day of , 20 <br />Civil City of South Bend <br />Printed Name of Signatory <br />STATE OF <br />SS: <br />COUNTY OF ) <br />Before me, the undersigned, a Notary Public in and for said County and State, <br />personally appeared , the of the Owner, <br />, who acknowledged the execution of the foregoing <br />instrument for and on behalf of said entity. <br />Witness my hand and Notarial Seal this day of , 20 <br />Residing in <br />My Commission Expires: <br />This instrument prepared by: <br />, Notary Public <br />County, <br />I affirm, under the penalties for perjury, that I have taken reasonable care to redact each <br />Social Security number in this document, unless required by law. <br />(Printed Name of Declarant) <br />7 <br />