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SALES DISCLOSURE FORM <br />slate Form 46021 (R3/1-00) <br />Approved by State Board of Accounts, 20oo <br />Prescribed by the State Board of Tax Commissioners, 1999 <br />Pursuant to IC 6-1.1-5.5 <br />First name(s) <br />City of South Bend, Indiana <br />Address (number and street) <br />1300 County —City Bldg. <br />City, Town or Post Office <br />South Bend <br />First name(s) <br />William T. Hoover and Mattie B. Ho ver <br />Last name(s) <br />Primary residence? <br />❑ Yes ❑ No <br />State I ZIP code <br />Last name(s) <br />Address (number and street) Primary residence? <br />1342 East Howard Street Yes ONO <br />City, Town or Post Office I State ZIP code <br />Send tax bills and notices to this address? <br />7 Yes O No <br />Street address <br />1340 Howard Street <br />City, Town or Post Office <br />South Bend <br />IN 46628 <br />If no, provide mailing address (number and street, city, state, ZIP code) <br />46601 <br />Stale ZIP code <br />IN 46628 <br />County Township School Corporation Name <br />St. Joseph I Portage <br />EXEMPT TRANSACTIONS (see instructions on reverse side) <br />Exempt Transaction? I(yes, specify the number of the exemption. (see "Exempt Transactions" on reverse side) <br />❑ Yes ❑ No <br />SALES INFORMATION <br />1. Total sales price $ 3 7 g. 58 <br />DATE OF SALE <br />Month Day Year 2. Seller paid paints $ <br />3. Net sales price (fine 1 minus line 2) $ 3 7 9 • 5 8 <br />Check ALL of the following conditions that apply to this sale. <br />❑ Transter of entire parcel ❑ Purchase of adjoining land ❑ Vacant land ❑ Exchange forh <br />'i��'6yl de') <br />❑ Seller provided financing ❑Mobile Home ❑ Condominium ❑ Split(s) ❑ Existence of family or business relationship between buyer and seller ❑ Personal property Included in transfer (Es(0-c <br />to �- �- � <br />Describe any unusual or special circumstances related to this sale, Including the specification of any less -than -comp ov t:r l'iileP t, an <br />the terms of any seller financing. 0 0 � � � l.) <br />x L <br />� <br />County Auditor must verify and complete the following information: <br />❑ Buyer and Seller information ❑ Sales price <br />❑ Address of property transferred ❑ Conditions of sale <br />❑ Date of sale/transfer <br />County Assessor must verify and complete the following Information: <br />❑ Significant physical changes to property between March 1 and date of sale <br />❑ Current properly record card attached <br />❑ Property crass I use code <br />❑ Parcel / Key number < _� <br />❑ School corporation numbkN <br />❑ Warranty deed? ❑ YES <br />ASSESSED VALUE (AV) INFORMATION <br />AV LAND $ <br />AV IMPROVEMENT(S) $ <br />AV TOTAL $ <br />The parties to a real property conveyance are required to file this form and attest in writing and under the penalties of perjury that the information contained <br />herein is true and correct. A person who knowingly and Intentionally falsifies or omits any information required on this form commits a Class A lnttaction. <br />Under penalties of perjury, I thereby cerfify that this Sales Disclosure, to [tie best of my knowledge and belief, Is true, correct and complete as required <br />by law, and is prepared in accordance with IC 6-1.1-5.5, "Real Property Safes Disclosure Act." <br />Stgna ur of Seller or rep sent live Telephone number Date signed (month, day, year) <br />� MUJJ Itw<�� _7 <br />L. Bodnar As City Attorney 574-235-9241 /� <br />Signature of Buyer or representative Telephone number Date signed (month, day, year) <br />