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Page 2 of 2 <br />Annexation Application Checklist <br />☐1. Completed Application Form☐2. Site Plan (drawn to scale)☐3. Subdivision Application (if required)☐4. Criteria for Decision Making (if required)☐5. Filing Fee <br />Contact Information <br />Name: <br />Address: <br />Phone Number: Email: <br />Property Owner Information (attach additional ownership list on separate page, if necessary) <br />Property Owner: <br />Property Owner Address: <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 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 ways: <br />Email: zoning@southbendin.gov <br />Mail: 215 S Dr. Martin Luther King Jr Blvd., Suite 500, South Bend, IN 46601