A. Assurance statement as follows:

ASSURANCE STATEMENT:

Assurance in the form of a _________, issued from _______________ in the amount of $________has been deposited with the Town Engineer to guarantee construction of the required subdivision improvements.

B. Conveyance and dedication statement as follows:

CONVEYANCE AND DEDICATION:

KNOW ALL MEN BY THESE PRESENTS THAT (OWNER'S NAME), AS OWNER, HAVE SUBDIVIDED (OR RE-SUBDIVIDED) UNDER THE NAME OF (NAME OF SUBDIVISION), (ADD SECTION, TOWNSHIP AND RANGE) OF THE GILA AND SALT RIVER BASE AND MERIDIAN, MARICOPA COUNTY, Arizona AS SHOWN PLATTED HEREON, AND HEREBY PUBLISHES THIS PLAT AS AND FOR THE PLAT OF SAID (SUBDIVISION NAME), AND HEREBY DECLARES THAT SAID PLAT SETS FORTH THE LOCATION AND GIVES THE DIMENSIONS OF ALL LOTS, EASEMENTS, TRACTS AND STREETS CONSTITUTING THE SAME, AND THAT EACH LOT, TRACT AND STREET SHALL BE KNOWN BY THE NUMBER, LETTER AND NAME GIVEN EACH RESPECTIVELY, AND THAT (OWNER'S NAME), AS OWNER, HEREBY DEDICATES TO THE PUBLIC FOR USE AS SUCH THE STREETS AND HEREBY DEDICATES TO THE PUBLIC THE DRAINAGE AND PUBLIC UTILITY EASEMENTS AS SHOWN ON SAID PLAT. IN WITNESS

(OWNER'S NAME), AS OWNER, HAS HEREUNTO CAUSED ITS NAME TO

BE SIGNED AND THE SAME TO BE ATTESTED BY THE SIGNATURE OF (OWNER OR DESIGNATED SIGNATORY AND TITLE)

BY: ________________________ DATE: _______________

______________________________________________________

OWNER'S NAME AND TITLE

C. Notary acknowledgement statement as follows:

NOTARY ACKNOWLEDGEMENT:

State of Arizona)

COUNTY OF MARICOPA)

ON THIS, THE_____DAY OF_____________, (YEAR), BEFORE ME THE UNDERSIGNED (TITLE) PERSONALLY APPEARED (NAME)__________________________WHO ACKNOWLEDGES THAT HE/SHE EXECUTED THE FOREGOING INSTRUMENT FOR THE PURPOSES CONTAINED THEREIN.

IN WITNESS WHEREOF I HEREUNTO SET MY HAND AND OFFICIAL SEAL

_______________________________________________

NOTARY PUBLIC

________________________________________________

MY COMMISSION EXPIRES

D. Town approval certifications as follows:

TOWN APPROVAL:

APPROVED BY the Town COUNCIL OF Fountain Hills, Arizona, THIS ________ DAY OF___________________, (YEAR).___________

BY: ______________________ATTEST:_______________________

Mayor TOWN CLERK

APPROVALS:

THIS PLAT WAS APPROVED BY the Town ENGINEER AND THE COMMUNITY DEVELOPMENT DIRECTOR.

BY: ______________________________________

TOWN ENGINEER

DATE: ____________________________________

BY: ______________________________________

DATE: ____________________________________

COMMUNITY DEVELOPMENT DIRECTOR

E. Surveyors certification as follows:

SURVEYORS CERTIFICATION:

THIS IS TO CERTIFY THE SURVEY AND SUBDIVISION PREMISES DESCRIBED AND PLATTED HEREON WERE MADE UNDER MY DIRECTION DURING THE MONTH OF___________, (YEAR), THAT THE PLAT IS CORRECT AND ACCURATE, THAT THE MONUMENTS SHOWN HEREON HAVE BEEN LOCATED OR ESTABLISHED AS DESCRIBED AND LOT CORNERS HAVE BEEN PERMANENTLY SET.

___________________________________________________________

(SURVEYOR'S NAME AND REGISTRATION NUMBER) (STAMP)

_____________________________________________________________

(SURVEYOR'S ADDRESS)