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PART 2 - COUNTY ASSESSOR <br />The county assessor must verify and complete items 1 through 14 and stamp the sales disclosure form before sending it to the auditor: <br />1. Property (Parcel Number) <br />2. AV of Land <br />3. AV of Improvement <br />4. Value of Depreciable <br />Personal Property <br />A.) <br />5. AV Total <br />6. Property Class Code <br />7. Neighborhood Code <br />8. Tax District <br />9. Acreage <br />A.) <br />10. Identify physical changes to <br />YES NO CONDITION <br />Assessor Stamp <br />p <br />property between the assessment date <br />O O 11. Is form completed? <br />and the date of sale: <br />12. State sales disclosure <br />O O fee required? <br />13. Date of Sale (mm/dd/yyyy): <br />14. Date Form Received (mm/dd/yyyy) <br />Items 15 through 18 are to be completed by the assessor when validating this sale: <br />YES NO CONDITION <br />15. If applicable, identify any additional special circumstances relating to validation of sale: <br />O O 16. Sale valid for trending? <br />O ❑ 17. Validation of sale <br />complete? <br />18. Validated by: <br />PART 3 - COUNTY AUDITOR <br />YES NO CONDITION <br />Auditor Stamp <br />1. State Sales Disclosure Fee Amount Collected: $ <br />❑ ❑ 6. Is form completed? <br />2. Other Local Fee: $ <br />❑ ❑ 7. Is state sales disclosure <br />fee collected? <br />3. Total Fee Collected: $ <br />❑ O 8. Attachments complete? <br />4. Auditor Receipt Book Number: <br />5. Date of Transfer (mm/dd/yyyy): <br />PART 4 - RECEIPT FOR STATEMENT OF DEDUCTION OF ASSESSED VALUATION <br />SDF ID <br />SDF Date (mm/dd/yyyy) <br />Buyer 1 — Name as appears on conveyance document <br />Parcel Number <br />Address of Property (number and street) <br />Check those deductions for which the individual has applied: <br />❑ Homestead ❑ Solar Energy ❑ Wind Power <br />O Hydroelectric ❑ Geothermal <br />City, State, and ZIP Code of Property <br />Auditor Signature <br />Date (mm/dd/yyyy) <br />A person who knowingly and intentionally falsifies value of transferred real property, or omits or falsifies any information required to be <br />provided in the sales disclosure form, commits a Level 5 felony. <br />Page 4 <br />