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I <br />INDIANA SALES DISCLOSURE FORM <br />Page 2 <br />Seller 1 - Name or EnWy as appears on deed <br />Deister LLC et al <br />Address _ <br />2410 N. Grape Rd., Ste. 100 i 1 <br />City, Town, or Post Office Stale ZIP Code <br />Mishawaka — 4] JJ <br />Seller 2 - Name or Entity as appears on deed <br />Address <br />City, Town, or Post Office State ZIP Code <br />_j —1 _� _j <br />Title Company Name (if applicable) Title Company Phone <br />L -� JJJ-JJJ-JJI <br />1 - Name or Entity as appears on deed <br />City of South Bend Will this property be the <br />buyer's primary <br />Address residence? <br />1316 County -City Bldg, 227 W. Jefferson Blvd. 0 Yes No <br />City, Town, or Post Office State ZIP Code <br />South Bend JJ6 1� 1 <br />Buyer 2 - Name or Entity as appears on deed <br />Address mm <br />City. Town, or Post Office Stale ZIP Code <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 as required by law, and <br />Is prepared in accordance with IC 6-1.1-5.5, "Real Property Sales Disclosure Act". <br />Slgnatu a of Seller <br />Signat B <br />M��� <br />Ui7'1 / yI I O <br />Buyer Sign Dale <br />MM/DDfYYY1(Ag) <br />Seller Phone <br />Buyer J Phone-71 � (1 <br />- _0] /] <br />PART 3 - COUNTY OR TOWNSHIP ASSESSOR <br />County Assessor or other assessing offfcal must verify and complete the following information: <br />PART 2 - COUNTY AUDITOR <br />0 Significant physical changes to property between March 1 and date of sale <br />AUDITOR'S <br />Fit.F STAMP <br />$ <br />JJ AV LAND J —1 —1 .Propertycod class <br />use otle <br />$ <br />Taxing District (DLGF assignet <br />�AVIMPV JJJJJ <br />Completion n Yes O No <br />Date Entered in Transfer Book <br />[7/m/l 1 1 <br />AV TOTAL O Valid Sale <br />JJ jjj-1iiiiij <br />NEIGHBORHOOD CODE <br />I♦ A <br />