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0 <br />Orange Water and Sewer Authority <br />Dedication Form <br />Orange Water and Sewer Authority <br />400 Jones Ferry Road <br />Post Office Box 35 <br />Carrboro, NC <br />27510 <br />n recordation of final sewer outfall plat <br />flanks to be completed upo <br />Re: Elementary #10 Utilities Extension <br />Dear Sirs: <br />Orange County, North Carolina the current owner of Elementary School,#10, according <br />to Plat Book(s) at Page(s) of the Orange County Registry, does <br />hereby dedicate and convey unto Orange Water and Sewer Authority, its successors <br />and assigns, all of its right, title and interest in and to the sewer lines constructed in <br />accordance with final plat titled ,Project Number , <br />fieldwork dated <br />IN WITNESS WHEREOF, this letter is executed by the duly authorized officers of <br />Orange County, North Carolina and its corporate seal to be hereunto affixed, all on the <br />day and year first above written. <br />Orange County, North Carolina <br />ATTEST: <br />Donna S. Baker <br />Clerk to the Board of County <br />Commissioners <br />By: <br />Barry Jacobs <br />Chair, County Commissioners <br />NORTH CAROLINA <br />ORANGE COUNTY <br />I, , a Notary Public, hereby certify that (Attester) personally appeared <br />before me this day and acknowledged that he is the (Position of Company / Corporation), a corporation, <br />and that by authority duly given as the act of the corporation, the foregoing instrument was signed in its <br />name by its (Title), sealed with its corporate seal, and attested as its Secretary. <br />(Notary Public) <br />My Commission Expires: <br />