1125.01 REQUIRED STATEMENTS.
   The following statements shall be affixed on the subdivision plat:
   Situated in Section     Township     Range     County Ohio,
containing     acres and being the same tract as conveyed to     and
described in the deed recorded in Deed Book     page        , Defiance
County, Ohio.
The undersigned     hereby certify that the attached plat correctly represents
their        , a subdivision of lots     to        , inclusive, do here
accept this plat of same and dedicate to public (private) use as such all or parts of
the roads, boulevards, cul-de-sacs, parks, planting strips, etc., shown herein and not
heretofore dedicated.
The undersigned further agrees that any use of improvements made on this land shall be in conformity with all existing valid zoning, platting, health, or other lawful rules and regulations involving the applicable off-street parking and loading requirements of Hicksville, Ohio, for the benefit of himself and all other subsequent owners or assigns taking title from, under, or through the undersigned.
In Witness thereof        Day of     , 19   
Witness               Signed               
                                  
STATE OF OHIO
COUNTY OF DEFIANCE
Before me a Notary Public in and for said County came     who acknowledged the signing of the foregoing instrument to be their voluntary act and deed for the purposes therein expressed.
In witness whereof I have hereunto set my hand and affixed my official seal this    , 19   
            By               
I do hereby certify that I have surveyed the premises and prepared the attached plat and that said plat is correct, and that the monuments have been set as shown.
            By