No. 1510 approving the transfer of real property to the COSB

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r C t EXEMPT TRANSACTIONS hrescnbedforuseln St.Joseph County (8/93) Norwahstand,ng IC 5 14 3 a l.t,..S J, S sure form ,s nol a puh,c `y„%/ only be used by the S'd'e 89.1'3 :1' `�� y�,✓ Commiss,oners or pa's Jrs ac9r7 :n be'. or the State Bosro of Tar CoT >. cnr TO • s •• Fiat Nsme M I 1661 Name y Cit of South Bend, Department o Red Stir a SKunry n moor or Federal ID number (upt'OnAI) — ' - -- Aod,rss (numbs, end ihaA) t: 'Y. Town or POOL ON, e 1200 County -City Bldg. South Bend cusf N&Ta M I last N City of South Bend, Indiana Saar Secwnty, rumber or Fodgrat 10 number (operoas,) AOn,ass (numop and strew) Cary. Town or Post Office 1308 County -City Bldg. South Bend Aod,si7 (number AV SV"f) City, Town or Fosl 07¢e 306 and 308 S. Chapin South Bend parGOr Or Key num!>♦r 18- 3051 -2002; 18- 3051 -2001 Co: r'y I Townsnrp nwne or +-try c "A 0010 )carte Dne) ❑ Residential ❑ Commercial ❑ Industrial ❑ Mineral ❑ Agricultural ❑ Other (specify) 46601 _ I I Sm• Z.p � I N �n 01 5 '..r,@ 20r-x: IN 146601 rM i _oes Me trantlact.01 I y as an ex mpr banit -ion? II Yes, opacity the number of the exemption and slop to the signature section below (To determine the numoer of ire Yes �] No exemption see section entitled *Exemp( Transactions' below) Reason number Exempt Transectlons - -,�� -- it a dor - -mant to be recorded clearly indicates that it is an exempt transaction, please cattily that the Iransaction is exempt and provida the reason number Socurtty interest document such as mortgage and trust deeds 7 Transfer for no consideration or gilt 2 leases that are for a term of less than ninety (90) years 8 Documents involving the partition of land tenants in common, io-ni rename if t 3 Document for compulsory transactions as a result of foreclosure or express threat of tenants by the entirety foreclosure• divorce, court order, condemnation or probate 9 As recording to correct prior recorded document a Transfer to a charity to Deeds placed in escrow prior to July 1, 1693 5 Agreements and other documents for mergers, consolidations and incorporations 1 I Easements / Right of Way Grants for no consideration ,nvolsrng solely nonl sled stock 12 Documents executed prior to July 1. 1993, but not p(evrousty recorded 6 Ouftiaim deeds not serving as a source of title no pAnres to a rest property conveyance document are required to file this form and attest in writing and under the penalties of perjury that the fnlormation coma ne9 hole r is tral, ar- _:rroct A person who knowingly and intentionally falsities any information required on this form commits a Class C misdemeanor _^ Jnder Penalties of Perjury, I hereby certify that this Salse Disclosure, to the beet of my knowledge and belief, Is true, correct and complete as required by law, and Is p-epered In accordance with IC e- 1.1•S.b, "Real Property Sales Disclosure Act ". r an exarrpt transaction only one signature (seller, buyer or either's representative) is required ^:.i�•. tit o.,ye' or VD'•a•rU4v Data 60ned'monrn d ,iy y +r, 1 I r r