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CITY OF SOUTH BEND, INDIANA <br />by: <br />printed: _ <br />its; <br />dated: <br />STATE OF INDIANA ) <br />ss: <br />COUNTY OF ST. JOSEPH ) <br />Before me the undersigned, a Notary Public in and for said County and State, personally <br />appeared __ ,the of the City of South Bend, Indiana, <br />who acknowledged the execution of the foregoing Indemnity Agreement. <br />Witness my hand and Notary Seal this day of , 2009. <br />Notary Public <br />[Notarial Seal] Printed Name: <br />Resident of County, ____ __ <br />My commission expires: <br />i <br />