Deed of Dedication - Dictate ROW along 35th Street – 3502 Oakcrest Dr.

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SALES DISCLOSURE FORM ssAr .q` State Form 46021 (R14 / 1-23) SDF ID �;+ _. d 1• Prescribed by Department of Local Government Finance County Year Unique ID Pursuant to IC 6-1.1-5.5 PRIVACY NOTICE: The telephone numbers and Social Security numbers of the parties on this form are confidential +••..._.__�. � P tY according to IC 6-1.1-5.5-3. Do NOT place personally identifiable information (e.g. consulate numbers, passport numbers; government ID numbers, etc.) on this form as it may become publicly available. NOTE: All a uestions must be answered to the best of the individual Is abili ty. If the questian does not app ly, write "NIA" In th spa cgrovided. 1f the information re quested is unknown leave the space provided blank. Failure to provide a res onse for t italicized fields shall not result in the resection of the underlying conveVance document by local_o_fficials. INSTRUCTIONS: For additional information on how to complete this form, see the Sales Disclosure Form Instructions. PART 1 — To be completed by BUYER/GRANTEE and SELLER/GRANTOR A. PROPERTY TRANSFERRED — Must be conveyed on a single conveyance document (Additional contiguous properties can be listed on Page 5.) 1. Parcel Number or Tax Check all boxes 5. Complete Address of Property 6. Complete Tax Billing Address (if Identification Number applicable to parcel. different from property address) A.) 71-09-08-232-001.000-0 0 2. split 3502 Oakcrest Drive 26 O 3. Land South Bend, IN 46615 ❑ 4. Improvement 7. Legal Description of Parcel: Lot 47 Bercliff Estate B. CONDITIONS — Check only those that apply. If condition 1 applies, filer is subject to disclosure and a disclosure filing fee. YES NO CONDITION YES NO CONDITION O O 7. Easements or right-of-way grants. (Please O ❑ 1. A transfer of real property interest for valuable note that: (i) public utility/govemmental consideration. easements; or (ii) rights -of -way that do not ❑ Or 2. Buyer is an adjacent property owner. transfer fee simple; do not require a sales ❑ O 3. Vacant land (No structures on land) disclosure form. See the instructions for more information.) If conditions 8-10 apply, filers are subject to disclosure, but ❑ p 4. Exchange for other real property (`Trade") Parcel Number of traded property: not to the disclosure filing fee. ❑ O 5. Land contract. ❑ Q 8. Document for compulsory transactions as a Contract term (YYYY-YYYY): result of foreclosure or express threat of Contract date (MM/DD/YYYY): foreclosure, divorce, court order, judgment, condemnation, eminent domain, or probate. ❑ 0 6. Partial interest. Describe: ❑ ❑r 9. Documents involving the partition of land between tenants in common, joint tenants, or tenants by entirety. 0 O 10. Transfer to a charity, not -for -profit ` organization, or governmental entity or agency- C. TRANSACTION DETAILS — Complete only those that apply. YES NO 6. Transaction includes multiple Sales Disclosure Forms? YES NO CONDITION ❑ O 1. Sheriff Sale or Tax Sale ❑ Or SDF Form of 7. Date conveyance document signed (MM/DD/YYYY): ❑ © 2. Short Sale ❑ O 3. Quitclaim Deed 8. Approximate number of days property was on the market: 0 9. Total number of parcels on this disclosure: 1 ❑ O 4. Auction 5. Other: (If there is more than one (1) parcel, see Page 5.) 10. Select the type(s) of property below and fill out corresponding page(s). Check all that apply. Residential r Agricultural (Complete Page 2, Sec. D-E) (Complete Page 2, Sec. D-E) Commercial Industrial ❑ (Complete Page 2, Sec. F-G) O (Complete Page 2, Sec. F-G) Page 1