This is to certify that the undersigned is/are
the owner(s) of the land described in the annexed plat and that I/we
have caused the land to be surveyed and subdivided as indicated thereon
for the uses and purposes set forth herein. I/we also certify to the
best of my/our knowledge that all recorded and unrecorded easements,
restrictions, reservations or covenants have been indicated on the
annexed plat. I/we hereby acknowledge and adopt the same as my/our
act this ____________________ day of ____________________, 20_____.
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(Signature of owner)
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(Typed or printed name of owner)
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STATE OF
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COUNTY OF
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ON THIS _______ DAY OF ____________________,
20_____, BEFORE ME, THE UNDERSIGNED OFFICER, PERSONALLY APPEARED_______________
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KNOWN TO ME (OR SATISFACTORILY PROVEN) TO BE
THE PERSON WHOSE NAME IS SUBSCRIBED TO THE WITHIN INSTRUMENT AND ACKNOWLEDGED
THAT HE EXECUTED THE SAME FOR THE PURPOSES THEREIN CONTAINED. IN WITNESS
WHEREOF I HEREUNTO SET MY HAND AND OFFICIAL SEAL.
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Notary Public
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This is to certify that the annexed plat of
subdivision/site plan was approved by the Planning Commission of Queen
Anne's County on the ___________________ day of ___________________,
20_____.
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(Signature of Chairman
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or Secretary of Planning Commission)
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This is to certify that the undersigned, Registered
Maryland Land Surveyor No. ______, has surveyed and subdivided the
property as described and shown on the annexed plat and that such
plat is a correct representation of that survey and subdivision. All
distances are shown in feet and decimals thereof. All lots meet the
requirements of the Queen Anne's County Zoning Ordinance in regard
to lot area, width and buildable area.
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I further certify that this subdivision is/is
not situated within 500 feet of a surface drain or water course serving
a tributary area of 640 acres or more.
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As witness, my hand and seal this _____ day
of ________, 20_____.
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(Signature of surveyor)
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(Typed or printed name of surveyor)
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(Address of surveyor)
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The Finance Officer of Queen Anne's County hereby
certifies that there are no delinquent general taxes and no redeemable
tax sales against any of the land shown on the annexed plat and that
I have received all fees and taxes assessed against such land.
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As witness, my signature, this _____ day of
_____________, 20_____.
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(Signature of County Finance Officer)
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The undersigned County Attorney for Queen Anne's
County, hereby certifies that acceptable surety for required improvements
shown on the annexed plat has been furnished in accordance with the
Queen Anne's County Zoning Ordinance.
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(Signature of County Attorney or
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Planning Commission Attorney)
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(typed or printed name of Attorney)
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This is to verify that the annexed plat of subdivision
was approved by the Department of Public Works of Queen Anne's County
on the _____ day of __________________, 20_____.
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(Signature)
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This is to verify that the annexed plan of subdivision
was approved by the Environmental Health Department of Queen Anne's
County on the _____ day of _______________, 20_____.
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(Signature)
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This is to certify that the annexed plat of
subdivision was approved by the Department of Planning of Queen Anne's
County on the ______ day of ________________, 20_____.
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(Signature of Planning Director)
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This is to certify that the annexed plat of
subdivision was approved by the Department of Emergency Services -
Office of the Fire Marshal on the ______ day of ________________,
20_____.
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(Signature)
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