As owner(s), I (we) hereby certify that I (we) caused the land
described on this plat to be surveyed, divided, mapped and dedicated
as requested on the plat. I (we) also certify that this plat is required
by W.S.A., § 236.10 or W.S.A., § 236.12 to be
submitted to the following for approval or objection: (list governing
bodies required to approve or who may object to the plat).
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Witness the hand and seal of said owner(s) this _______ day
of ____________, 19 _____.
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In presence of:
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(Seal)
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owner's name
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(Seal)
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owner's name
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State of Wisconsin)
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) SS
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__________ County)
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Personally came before me this _____ day of _____, 19 _____,
the above named __________ to me known to be the person who executed
the foregoing instrument and acknowledged the same.
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(Notary Seal)
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Notary Public, , Wisconsin
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My commission expires .
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(corporate name)
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a corporation duly organized and existing under and by virtue
of the laws of the State of Wisconsin, as owner, does hereby certify
that said corporation caused the land described on this plat to be
surveyed, divided, mapped and dedicated as represented on this plat.
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(corporate name)
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does further certify that this plat is required by W.S.A., § 236.10
or W.S.A., § 236.12 to be submitted to the following for
approval or objection: (list governing bodies required to approve
or who may object to the plat).
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In witness whereof, the said __________ (corporate name) has
caused these presents to be signed by __________, its president, and
countersigned by __________, its secretary (cashier), at __________,
Wisconsin, and its corporate seal to be hereunto affixed on this _____
day of __________, 19 _____.
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In the presence of:
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Corporate Name
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(Corporate Seal)
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President
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Countersigned:
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Secretary or Cashier
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State of Wisconsin)
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) SS
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__________ County)
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Personally came before me this _____ day of _____, 19 _____,
President, and __________, Secretary (cashier) of the above named
corporation, to me known to be the persons who executed the foregoing
instrument, and to me known to be such President and Secretary (cashier)
of said corporation, and acknowledged that they executed the foregoing
instrument as such officers as the deed of said corporation, by its
authority.
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(Notary Seal)
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Notary Public, __________, Wisconsin
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My commission expires __________.
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I, __________, mortgagee of the above-described land, do hereby
consent to the surveying, dividing, mapping and dedication of the
land described on this plat, and I do hereby consent to the above
certificate of __________, owner.
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Witness the hand and seal of __________, mortgagee, this _____
day of ________, 19 _____.
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In the presence of:
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(Seal)
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Mortgagee
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State of Wisconsin)
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) SS
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__________ County)
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Personally came before me this _____ day of _____, 19 _____,
the above named __________, to me known to be the person who executed
the foregoing instrument and acknowledged the same.
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(Notary Seal)
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Notary Public, __________, Wisconsin
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My commission expires __________.
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__________ (corporate name), a corporation duly organized and
existing under and by virtue of the laws of the State of Wisconsin,
mortgagee of the above-described land, does hereby consent to the
surveying, dividing, mapping and dedication of the land described
on this plat and does hereby consent to the above certificate of __________,
owner.
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In witness whereof, the said __________ (corporate name) has
caused these presents to be signed by __________, its President, and
countersigned by __________, its Secretary (cashier), at __________,
Wisconsin, and its corporate seal to be hereunto affixed this _____
day of __________, 19 _____.
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In the presence of:
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Corporate Name
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(Corporate Seal)
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President
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Countersigned:
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Secretary or Cashier
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State of Wisconsin)
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) SS
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________________County)
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Personally came before me this _____ day of _____, 19 _____,
__________, president and __________, secretary (cashier) of the above
named corporation, and to me known to be such president and secretary
(cashier) of said corporation, and acknowledged that they executed
the foregoing instrument as such officers as the deed of said corporation,
by its authority.
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(Notary Seal)
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Notary Public, __________, Wisconsin
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My commission expires __________.
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State of Wisconsin)
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) SS
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Walworth County)
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I, __________, city engineer of the City of Lake Geneva do hereby
certify that the land improvements described in this final plat and
plans and specifications therefor and street names shown in said plat
meet the requirements of the City of Lake Geneva and have been approved
by all public authorities having jurisdiction.
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Dated at Lake Geneva, Walworth County, Wisconsin, this _____
day of _____, 19 _____.
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City Engineer
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State of Wisconsin)
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) SS
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Walworth County)
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I, __________, being the duly appointed, qualified and acting
city clerk of the City of Lake Geneva, Wisconsin, do hereby certify
that copies of this plat were forwarded to all public authorities
having jurisdiction as required by W.S.A., § 236.12(2) on
the _____ day of __________, and that within the twenty-day limit
set by W.S.A., § 236.12(3) (no objections to the plat have
been filed) (all objections to the plat have been met).
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City Clerk
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Date
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State of Wisconsin)
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) SS
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Walworth County)
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Approved this _____ day of _____, 19_____.
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Lake Geneva Plan Commission
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Chairman
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Resolved, that the plat of __________, in the City of Lake Geneva,
Wisconsin, owner(s) be and the same, is hereby approved by the city
council.
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Signed
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President of the City Council
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I hereby certify that the foregoing is a true copy of a resolution
duly adopted by the city council of the City of Lake Geneva, Wisconsin,
on the _____ day of _____, 19 _____.
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City Clerk
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Know all men by these presents, that: we, _____ as principal
and as surety, are firmly bound to the City of Lake Geneva, Wisconsin,
in the penal sum of $_____, lawful money of the United States of America,
for the payment of such sum, well and truly to be made, we bind ourselves,
our heirs, executors, administrators and assigns, jointly and severally,
by these presents.
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The condition of the above obligation is such that:
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Whereas, __________ has obtained, according to law and ordinances
of the City of Lake Geneva, approval of the (Plat of __________),
being a Subdivision of __________ in Walworth County, Wisconsin, conditioned
upon: (a) that by _____ date the making of certain land improvements
to wit: __________ _____ as more fully described in plans dated _______
and prepared by __________; (b) the execution and delivery of this
bond.
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Now, if the said __________ shall well and faithfully and in
a good and workman-like manner of good materials according to law
and ordinances of the City of Lake Geneva, and in conformity with
said plans dated __________ construct said improvements.
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Then this obligation shall be null and void; otherwise, the
same shall remain in full force and effect.
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In witness whereof, we have hereunto set our hands and seals
this _____ day of __________, 19 _____.
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Principal
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Surety
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NOTARY CERTIFICATE
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State of Wisconsin)
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) SS
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County of Walworth)
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I, __________, a Notary Public in and for said County, in the
state aforesaid, do hereby certify that __________ personally known
to me to be the same persons whose names are subscribed to the foregoing
instrument, appeared before me this day in person and acknowledged
that they signed the above instrument as their own free and voluntary
act for the uses therein set forth.
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Given under my hand and Notorial Seal this _____ day of __________,
19 _____.
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Notary Public
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