The certificates quoted below shall be inscribed on the plan as quoted and shall be properly signed and attested when the plan is submitted to the governing body. All certificates shall be placed on the final plan in an arrangement suitable for placement of all required seals.
A. 
Owner's Adoption (Individual).
KNOW ALL MEN BY THESE PRESENTS, THAT
(I or We)
of the (Name of Owner or Owners)
(City, Borough, Township) of _________________________, County of___________________ State of
_____________________for (myself, ourselves), (my, our) heirs, executors, administrators and assigns, do hereby adopt this as (my, our) Plan of Subdivision of (my, our) property, situate in the Township of Rostraver, County of Westmoreland and Commonwealth of Pennsylvania and for divers advantages accruing to (me, us), hereby dedicate forever, for public use for highway, drainage, sewage and utility purposes, all drives, roads, streets, lands, rights-of-way, easements, ways and other public highways shown upon the Plan, with the same force and effect as if the same had been opened through legal proceedings and in consideration of the approval of said plan and any future acceptance of said public highways, rights-of-way and easements by said County of Westmoreland and Township of Rostraver.
(I or We),
(Name of Owner or Owners)
hereby agree to and by these presents do release and forever discharge said County of Westmoreland and said Township of Rostraver, their successors or assigns, from any liability for damages arising and to arise from the appropriation of said ground for public highways and other public uses and the physical grading thereof to any grades that may be established. This dedication and release shall be binding upon
(my, our) heirs,
(Name of Owner or Owners)
executors, administrators and assigns and purchasers of lots in this plan.
IN WITNESS WHEREOF, (I or We) hereunto set (my, our) hand(s) and seal(s) this __________________ day of _____________________, A.D., ______.
Attest:
(SEAL)
(Owner or Owners)
(SEAL)
Notary Public
(Owner or owners)
My Commission Expires the ___________________day of
__________________, A.D., ______.
The foregoing adoption and dedication is made by
(Name of individual Owner)
with the full understanding and agreement that the approval of the governing body of the Township of Rostraver, if hereto attached, will become null and void unless this plan is recorded in the Recorder of Deeds Office of Westmoreland County, County Court House, Greensburg, Pennsylvania, within 90 days of date of said approval.
B. 
Individual Acknowledgment.
COMMONWEALTH OF PENNSYLVANIA:
SS
COUNTY OF WESTMORELAND:
Before me, the subscriber, a Notary Public in and for said State and County, personally appeared the above named
(Owner)
and acknowledged the foregoing Release and Dedication and Plan to be (his, her, their) act and deed and desired the same to be recorded as such:
WITNESS MY HAND AND NOTARIAL SEAL this _____________ day of ______________________, _______.
(SEAL)
   Notary Public
C. 
Owner's Adoption (Corporation).
KNOW ALL MEN BY THESE PRESENTS, that
(Name of Corporation)
a corporation, by virtue of a resolution of the Board of Directors thereof, does hereby adopt this as its plan of lots of its property situate in the Township of Rostraver, Westmoreland County, Pennsylvania, and for divers advantages accruing to it does hereby dedicate forever, for public use for highway purposes, all drives, roads, streets, lanes and ways and other public highways shown upon the plan with the same force and effect as if the same has been opened through legal proceedings and, in consideration of the approval of said plan and any future acceptance of said public highways by the said Township of Rostraver, Westmoreland County, Pennsylvania, hereby covenants and agrees to and by these presents does release and forever discharge said Township of Rostraver, its successors or assigns from any liability for damages arising and to arise from the appropriation of said ground for public highways and the physical grading thereof to any grades that may be established. This dedication and release shall be binding upon
(Name of Corporation)
its successors and assigns and purchasers of lots in this plan.
ATTEST
(Name of Corporation)
By
  Secretary
          President
The foregoing adoption and dedication is made by
(Name of Corporate Owner)
with the full understanding and agreement that the approval of the governing body of the Township of Rostraver, if hereto attached, will become null and void unless this plan is recorded in the Recorder of Deeds Office of Westmoreland County, County Court House, Greensburg, Pennsylvania, within 90 days of said approval.
D. 
Corporation Acknowledgment.
COMMONWEALTH OF PENNSYLVANIA:
SS
COUNTY OF WESTMORELAND:
On this ____________ day of ______________________, A.D. ______, before me, a Notary Public in and for said County and State, personally appeared
(Name and Title of Officers)
(Name of Corporation)
who, being duly sworn, deposeth and saith that he was personally present at the execution of the adoption, release and dedication and saw the common and corporate seal of the said corporation duly affixed and that the above release and dedication was duly signed and sealed by and as for the act and deed of the said corporation, for the uses and purposes therein mentioned and that the name of the deponent subscribed to the said release and dedication as
of said corporation,
(Title of Officer)
attestation of the due execution and delivery of said release and dedication of this deponent's own proper and respective handwriting.
(SEAL)
  (Name of Officer)
(SEAL)
  (Title of Officer)
Sworn to and subscribed before me the day and date written.
WITNESS MY HAND AND NOTARIAL SEAL this _______________ day of __________________, ______.
(SEAL)
  Notary Public
My Commission Expires the ______________________________ day of
_________________, A.D., ______.
E. 
Westmoreland County Planning Commission Review.
[Amended 6-6-2018 by Ord. No. 701]
Reviewed and/or approved by the Westmoreland County Department of Planning and Development this _____ day of __________, _____.
Letter to the Rostraver Township Board of Commissioners dated
________________________________________, ______.
F. 
Proof of Recording.
COMMONWEALTH OF PENNSYLVANIA:
SS
COUNTY OF WESTMORELAND:
Recorded in the Office for the Recording of Deeds, Plats, etc., in said County, in Plan Book Volume ________________, page _______________. Given under my hand and seal this ___________________ day of _____________________, ______.
  Recorder of Deeds
G. 
Owner's Acceptance of Responsibility for Providing Stormwater Drainage Facilities and Control of Stormwater Drainage.
KNOW ALL MEN BY THESE PRESENTS, THAT
(I or We)
, of the Township of Rostraver,
County of Westmoreland, Commonwealth of Pennsylvania, for ourselves, our heirs, executors, administrators and assigns and for our grantees and their subsequent purchasers, do hereby accept full and complete responsibility, liability, expense and provision of facilities for the control of stormwater drainage over, across and through this subdivision of land until such time as (I or We), our heirs, executors, administrators and assigns construct stormwater drainage facilities in accordance with Township specifications and requirements and the same is officially accepted by action of the governing body and until such formal acceptance (I or We) for ourselves, our heirs, executors, administrators and assigns do hereby release the Township of Rostraver from any responsibility in connection therewith. This acceptance of responsibility shall be binding upon ____________________________
our heirs, executors, administrators and assigns and all purchases of lots in this plan of subdivision.
IN WITNESS WHEREOF, we hereunto set our hands and seals this ________ day of _____________________, A.D., ______
ATTEST
(SEAL)
  (Owner or Owners)
(SEAL)
  (Owner or Owners)
WITNESS My hand and notarial seal this _________ day of
________________________, ______.
SEAL)
  Notary Public
My Commission Expires the ____________day of
______________________, A.D., ______.
H. 
Surveyor's Certificate.
I, ___________________________, a registered surveyor of the State of Pennsylvania, do hereby certify that this plan correctly represents the lots, lands, streets and highways as surveyed and plotted by me for the owners or agents.
(SEAL)
  (Engineer)
  Registration No.
  Date
I. 
Highway Occupancy Permit Requirement.
[Amended 8-7-2002 by Ord. No. 467]
This plat requires a highway occupancy permit pursuant to Section 42G of the Act of June 1, 1945 (P.L. 1242 , No. 428), known as the "State Highway Law." Approval of the Rostraver Township Board of Commissioner is conditional, subject to action of the Pennsylvania Department of Transportation pursuant to application for a highway occupancy permit.
J. 
Approval by Board of Commissioners of Rostraver Township.
The Board of Commissioners of the Township of Rostraver, Westmoreland County, Pennsylvania, hereby approves this plan of subdivision for recording purposes only. This approval by the Township of Rostraver does not constitute an acceptance of the roads, streets, storm and sanitary drainage facilities, easements or rights-of-way, water mains or any other services or improvements shown on this plan, nor an assumption of maintenance responsibility, nor will the same be accepted or maintained until constructed in accordance with all Township specifications and requirements and officially accepted by action of the governing body. This approval shall in no way be deemed an authorization to commence construction or related activities. This plan of subdivision approved by resolution of the governing body of the Township of Rostraver, Westmoreland County, Pennsylvania, on this _____________day of__________________, ______.
ATTEST:
  Secretary
  Chairman
SEAL: