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g ��F SALES DISCLOSURE FORM , <br />state Form 46021 (R4M-04) PRIVACY NOTICE: The telephone <br />numbers of the parties on this form are III I <br />r, �Z Prescribed byDepartment ofLocal Government Finance confidential according to IC 6-1.1-5.5- j II III��IIIII�II�II��I{I IfIII��IIIII��I <br />Pursuant to IC 6-1,1.5 5 <br />+eis <br />..-1, 1, - .. . <br />Parcel Numberif necessary.) (Show additional parcels on separate sheet necessary.) Acreage or Lot Size 3 � � � (split <br />Part of Parclit e <br />2 5J1 0 2 5- JJ�JJJJJJJJJJ JJJ�1-1- 0 <br />JJJJJJ _JJJJJJJJJJJJJJ JJJJ'JJJ 0 <br />iii JJ LLJ 1 0 <br />Address <br />rl of Parcels <br />211 W. Ireland Rd. <br />J j q , <br />City, Town, or Post Office <br />State <br />ZIP Code <br />J J <br />South Bend <br />�J <br />JJJJ <br />JJJ <br />Tax Billmq Address (if other than nrooerty address) <br />d 1 1316 County -City Bldg, 227 W. Jefferson Blvd. <br />City, Town, or Post Office <br />State <br />ZIP Code <br />South Bend, <br />J I� <br />�JJ 1J <br />- JJJJ <br />Legal Description <br />see attached <br />Identify all conditionslitems that apply <br />O1-Buyer is an adjacent property owner <br />O2-Vacant Land <br />O3-Exchange for other real property ("Trade") <br />O4-Seller Paid Points; amount If applicable <br />❑ L <br />O5-Change planned in the primary use ofthe property? Describe in <br />special circumstances. <br />NOTE: If items 12-21 apply, filers are not subject to disclosure <br />filinq fee, <br />J6-Existence of family or business relationship between buyer and seller <br />O7- Land Contract Dated: <br />O8-Personal property included in transfer; amount If applicable <br />❑r�r�u <br />O9- Significant physical changes to property between March 1 and date of sale <br />O10- Non -Warranty deed; specify type <br />O11- Partial Interest. Describe In special circumstances. <br />a12-Security Interest documents such as mortgages or trust deeds. <br />O13-Leases less than 90 years <br />14-Document resulting from foreclosure, or express <br />threat of foreclosure, divorce court order, condemnation, <br />probate or otherjudicial proceedings. <br />O15-Agroomonts and other documants for <br />mergers, consolidations, and Incorporations <br />O16-Quitclalm deeds not serving as a source oftitle <br />O17-Documents involving the partition of land between <br />tenants In common, joint tenants, or tenants by the <br />entirety. <br />0 18-Transfer to a charity, not -for -profit or government <br />Institution <br />0 19-Transfer for no or discounted consideration, or gift <br />O20-Rerecording to correct prior recorded document <br />O21-Easements, Right-of-way grants <br />Contract Date (MWDD1YYYY) Sales Price <br />Z' 2Q S $ 1 5 FE5 <br />Describe any unusual or special circumstances related to this sale, Including the specification of any less -than -complete ownership interest and terms of seller f nancing, <br />Sale/Purchase 1,525 square feet of land for highway purposes. Price includes land, land improvements, and severance <br />damages. <br />1 <br />I <br />