1105.28 REQUIRED STATEMENTS AND SIGNATURES.
   (a)    The following statements shall be affixed on the subdivision plat:
 
 
DEDICATION
   KNOW ALL MEN BY THESE PRESENTS, that                                               and , proprietors of the land indicated on the accompanying plat, have authorized the platting thereof and do hereby dedicate the (streets, roads, parks) to the (public or private) use forever.
   Said buffer lot "A" is dedicated conditionally until such time as the adjacent land is subdivided and a part thereof is dedicated for the purpose of extending the public right-of-way hereon shown.
                                                                                    
                                                                                    
Witnesses               Proprietors
STATE OF OHIO
ss:
LOGAN COUNTY
Before me, a Notary Public in and for said County, personally came                                     ,
who acknowledge the signing of the foregoing instrument to be their voluntary act and deed for the uses and purposes therein expressed.
   IN WITNESS WHEREOF, I have hereunto set may hand and affixed my official seal
this                      day of                         , 19       .
                                               
   Notary Public
 
 
SURVEYOR'S CERTIFICATE
   The accompanying plat represents a subdivision of land in (S.T.R. or V.M.S.  No.),                               Township, City of Bellefontaine, Logan County, Ohio. The tract has an area of                    acres in streets and                      acres in lots, making a total of                      acres.
   All measurements are in feet and decimals of a foot. All measurements on curves are (chord or arc) distances.
   I hereby certify that the accompanying plat is a correct representation of (Subdivision Name) as surveyed (date) and that all monuments and iron pins as shown hereon have been set.
                                                             
            Registered Surveyor #                     
   The following paragraph shall be placed on the final plat if streets, roads, parks, etc., are dedicated to the public use:
   "The within (streets, parks, etc.) are hereby approved and accepted for public maintenance by Ordinance (Resolution) No.                       recorded in City Council's record book                      on this                 day of                                , 19          . "
                                           
Mayor
                                           
President, Bellefontaine City Council
                                           
Clerk of City Council
   (b)    The following approval and recording schedule shall be placed on the final plat:
 
Approved this           day of            , 19          ,                                  
                      Bellefontaine
                      City Engineer
Approved this             day of                , 19 ,                               
                     Chairman, City
                     Planning Commission
Transferred this                   day of                      , 19         ,                 
                         Logan County
                         Auditor
Filed for record this                   day of             , 19            , at     _m.
Recorded this          day of           , 19          in Plat Cabinet ,
Slide .
                                                              
                     Logan County Recorder