APPENDIX D: DEED OF DEDICATION CERTIFICATE
Each final plat submitted to the Commission for approval shall carry a deed of dedication in substantially the following form:
"We, the undersigned                     , owners of the real estate shown and described herein, do hereby certify that we have a laid off, platted and subdivided, and hereby lay off, plat and subdivide, said real estate in accordance with the within plat."
This subdivision shall be known and designated as                    an addition to                    .
All streets and alleys shown and not heretofore dedicated are hereby dedicated to the public.
Building setback lines are hereby established as shown on this plat, between which lines and the property lines of the street, there shall be erected or maintained no building or structure.
There are strips of ground shown on this plat and marked "Easement" reserved for drainage and the use of public utilities for the installation of water and sewer mains, poles, ducts, lines and wires subject at all times to the proper authorities and to the easement herein reserved. No buildings or other structures are to be erected or maintained upon said strips of land, but owners of lots in this subdivision shall take their titles subject to the rights of the public utilities.
Witness our Hands and Seals this               day of       , 20   .
STATE OF INDIANA )
         )SS:
COUNTY OF HOWARD )
Before me the undersigned NOTARY PUBLIC, in and for the County and State, personally appeared                 , and each separately and severally acknowledged the execution of the foregoing instrument as his or her voluntary act and deed, for the purpose therein expressed. Witness my Hand and Notarial Seal this             day of           ,
                    
   Notary Public
   My Commission Expires: