SITUATED IN THE STATE OF OHIO, COUNTY OF PICKAWAY, CITY OF CIRCLEVILLE, LYING IN SECTION __, TOWNSHIP __, RANGE __, CONTAINING ALL OF THE _______ ACRE TRACT CONVEYED TO _______________________ IN OFFICIAL RECORD VOLUME ___, PAGE ____, RECORDS OF THE RECORDER’S OFFICE, PICKAWAY COUNTY, OHIO.
THE UNDERSIGNED ___OWNER/DEVELOPER____, BY ___________________, TITLE AND/OR OWNER, BEING THE OWNER OF THE LAND PLATTED HEREIN, DULY AUTHORIZED IN THE PREMISES DO HEREBY CERTIFY THAT THIS PLAT CORRECTLY REPRESENTS THEIR ______________________ SUBDIVISION, LOTS __ THROUGH __ AND RESERVES __ AND __, INCLUSIVE AND DO HEREBY ACCEPT THIS PLAT OF SAME AND DEDICATE TO PUBLIC USE, AS SUCH, ALL OF THE DRIVES, PLACE, COURT AND PIKE SHOWN HEREON AND NOT HERETOFORE DEDICATED.
EASEMENTS, WHERE INDICATED ON THIS PLAT, ARE HEREBY GRANTED TO THE COMPANIES, MUNICIPALITIES OR ENTITIES PROVIDING PUBLIC UTILITY SERVICES, UNCLUDING BUT NOT LIMITED TO WATER, SANITARY SEWER, ELECTRICITY AND TELEPHONE, TO COMPANIES PROVIDING CABLE TELEVISION AND/OR CABLE SIGNAL TRANSMISSION SERVICES AND TO MUNICIPALITIES RESPONSIBLE FOR STORM WATER DRAINAGE SYSTEMS, FOR THE CONSTRUCTION OPERATION AND MAINTENANCE OF THE FACILITIES TO PROVIDE SUCH SERVICES ABOVE AND BENEATH THE GROUND AND WITH THE EXPRESS PRIVILEGE OF REMOVING ANY AND ALL TREES OR OTHER OBSTRUCTIONS TO THE FREE USE OF SAID EASEMENTS.
IN WITNESS WHEREOF, ____OWNER/DEVELOPER_______, ____TITLE___________, HAS CAUSED THIS PLAT TO BE EXECUTED THIS ______________ DAY OF ____________, 20__.
WITNESSES: | DEVELOPER |
______________________________ | ________________________________ |
NAME | |
PRINTED: _____________________ | TITLE |
_______________________________ | |
PRINTED: ______________________ |
STATE OF OHIO SS:
BEFORE ME, A NOTARY PUBLIC IN AND FOR SAID STATE, PERSONALLY APPEARED ____________________________________, TITLE, FOR SAID __________________________, WHO ACKNOWLEDGES THE SIGNING OF THE FOREGOING INSTRUMENT TO BE HIS FREE AND VOLUNTARY ACT AND DEED, AND THE FREE AND VOLUNTARY ACT AND DEED OF SAID __________________, FOR THE USES AND PURPOSES THEREIN EXPRESSED.
IN WITNESS WHEREOF, I HAVE HEREUNTO SET MY HAND AND AFFIXED BY OFFICIAL SEAL THIS ____ DAY OF ___________________, 20___.
MY COMMISSION EXPIRES __________________
________________________________
NOTARY PUBLIC, STATE OF OHIO
IN WITNESS WHEREOF, _________OWNER________, HAS CAUSED THIS PLAT TO BE EXECUTED THIS ____________ DAY OF __________________, 20___.
WITNESSES:
________________________________ | |
PRINTED: _______________________ | _____________________________ |
(OWNER) | |
________________________________ | |
PRINTED: _______________________ |
STATE OF OHIO SS:
BEFORE ME, A NOTARY PUBLIC IN AND FOR SAID STATE, PERSONALLY APPEARED ________________________, WHO ACKNOWLEDGES THE SIGNING OF THE FOREGOING INSTRUMENT TO BE HIS/HER FREE AND VOLUNTARY ACT AND DEED, FOR THE USES AND PURPOSES THEREIN EXPRESSED.
IN WITNESS WHEREOF, I HAVE HEREUNTO SET MY HAND AND AFFIXED BY OFFICIAL SEAL THIS _______________ DAY OF ________________, 20 ___.
MY COMMISSION EXPIRES: ____________________
________________________________
NOTARY PUBLIC, STATE OF OHIO
APPROVED THIS ___ DAY OF ____________, 20___
__________________________________________
CHAIRMAN, CIRCLEVILLE PLANNING COMMISSION
APPROVED THIS ___ DAY OF ____________, 20 ___
___________________________________________
DIRECTOR OF PUBLIC SERVICE
THIS ____ DAY OF _____________, 20___, RIGHTS-OF-WAY FOR ALL STREETS, ALLEYS, ROADS, ETC. HEREIN DEDICATED FOR PUBLIC USE ARE HEREBY APPROVED AND ACCEPTED AS SUCH FOR THE CITY OF CIRCLEVILLE (PICKAWAY COUNTY) PURSUANT TO ORDINANCE (RESOLUTION) NUMBER _____________________ DATED ____________________, 20 ____.
________________________________________ CLERK OF COUNCIL | ________________________________________ DATE |
AND/OR | |
_____________________________ |
_____________________________ |
_____________________________ |
_____________________________ |
TRANSFERRED THIS ______ DAY OF ______________, 20 ___
_______________________________________
AUDITOR, PICKAWAY COUNTY, OHIO
FILED FOR RECORD THIS ____ DAY OF ____________________, 20__ AT ___:___ _.M.
RECORDED THIS _____ DAY OF ______________________, 20 ___ PLAT CABINET ____ SLIDES _____________
_______________________________________
RECORDER, PICKAWAY COUNTY, OHIO