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C <br />,. ,ES DISCLOSURE <br />Stale Form 461121'RI 11.981 <br />Prescribed by the State Board of Tax Commissioners 1998 <br />Pursuant to IC 6 1998 <br />Approved by Stale Board of Accounts, <br />First name(s) <br />Address (nljmber and street) <br />1400 County City Bldg. <br />City, Town or Post Office <br />South Bend <br />First name(s) <br />John and Donnelda <br />Address (number and street) <br />28600 M-60)oWest <br />City, Town or Post Office <br />Cassopolis <br />Send tax bills and notices to this <br />if no, <br />addioss7 - n yes M No <br />Address (number and slreel) <br />City, Town or Post Office <br />South Bend <br />County <br />St. Joseph <br />9 <br />I Last name(s) <br />Last name(s) <br />Lohr <br />EXEMPT TRANSACTIONS see in <br />transaction? If Yes, specify the exempti�noth <br />r <br />(see 'Exempt Transactionr side) <br />Yes ❑ No <br />SALES INFORMA <br />1. Total Sales Price <br />DATE OF SALE <br />2. Seller Paid Points <br />Month Day <br />7672 <br />s <br />reverse <br />5 1 g g g 3. Net Sales Price (item 1 minus item 2) <br />Check ALL of the following conditions that apply to this sale: <br />❑ Transfer of entire parcel WVacant Land ❑ Exchange for other Real <br />Property ("Trade") <br />❑ Existence of a family or business ❑ Personal Property included in ❑ Condominium <br />relationship between buyer and seller transfer (estimated value <br />❑ Seller provided financing $ ) ❑ Mobile Home <br />Describe any unusual or special circumstances related to this sale, including the specification of any less 1 <br />the terms of any seller financing: <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 <br />date of sale <br />❑ Current Property Record Card Attached <br />Property Class / Use Code: <br />Parcel / Key Number: <br />Warranty Deed? <br />Notwithstanding IC 5.14.3, a sales disclo- <br />sure form is not a public record and may only <br />be used by the State Board of Tax <br />Commissioners, persons acting on Its behalf, <br />or officials acting under the authorization of <br />P.L. 84.1995 Sec. 7. <br />ite ZIP code <br />IN 1 46601 <br />ite ZIP code <br />M1 49031 <br />State ZIP code <br />School corporation <br />$500-00 <br />$500.00 <br />❑ Purchase of adjoining land <br />❑ Split(s) <br />complete ownership interest, <br />❑ Yes ❑ No <br />ASSESSED VALUE <br />AV Land: <br />AV Improvement(s) <br />AV Total: <br />INFORMATION <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 intraction. <br />Under Penalties of Perjury, I hereby certify that this Sales Disclosure, to the best of my knowledge and belief, is true, correct and complete <br />as required by law, and is prepared in accordance with IC 6-1.1-5.5, "Real Property Sales Disclosure Act". <br />Signature r or representative Telephone number Date signed (month, day, year) <br />(219 ) 235-9241 6/2-5/99 <br />Sig re Kruyer or representative Telephone number Date signed (month, day, year) <br />