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<br />iHJ J 4 6 4
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<br />CORPORATE OWNER'S CERTIFICATE
<br />Stoughton Hospital Association, a corporation duly organized and existing by the virtue of the laws of the State of
<br />Wisconsin, as owner does hereby certify that said corporation caused the lands described on this Certified Survey Map
<br />to be surveyed, divided, and mapped as represented on this Certified Survey Map.
<br />
<br />Stoughton Hospital Association, does further certify that this Certified Survey Map is required by S. 75.17(1)( a), Dane
<br />County Code of Ordinances to be submitted to the Dane County Zoning and Natural Resources Committee approval
<br />or objection.
<br />
<br />lNWITNESS WHEREOF, the said Stoughton Hospital Association, has caused these presents to be executed and
<br />signed by Terry Brenny, Chief Executive Officer, at Stoughton, Wisconsin, and its corporate seal to be hereto
<br />affixed this ;),,0 day of :s vA.) e ,2005.
<br />
<br />
<br />Stoughton Hospital Association
<br />(Seal)
<br />
<br />STATE OF WISCONSIN)
<br />COUNTY OF DANE ) ss.
<br />Personally came before me this ~ day of ,2005, TenyBrenny,
<br />to me known to be the Chief Executive Officer of the Stoughton ospital Association and acknowledge that he
<br />executed the foregoing instrument as such officer as the deed of said corporation, by its authority, for the purposes
<br />therein contained.
<br />
<br />~ ~"')G-..'-J--~
<br />
<br />Notary Pu~li~. Dane coun~ot
<br />My Comrmsslon 0
<br />
<br />COMMON COUNCIL APPROVAL
<br />CITY OF STOUGHTON, WISCONSIN
<br />I, Luann 1. Alme do hereby certify that I am the duly appointed, qualified and acting
<br />City Clerk of the City of Stoughton, and that this Certified Survey Map was
<br />approved by the City Council of the City of Stoughton, Dane County, Wisconsin
<br />on the I~ '1'\, day of tJ..p ri-( ,2005.
<br />
<br />Office Map No.
<br />Sheet 4 of 4 Sheets
<br />
<br />15277 Document No. 4o'7c.l L '-t D
<br />Certified Survey Map No. lit..[ ~ Volume ItJ c]
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<br />Luann J. Alme, City of Stoughton Clerk
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