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r <br />SALES DISCLOSURE FORM <br />Slale Form 46021 (R094)4) <br />w: - <br />'r'� ,a Pfesmbed by Ceponmert at Local Govemment Finance <br />Pcrsvanl to iC 6-1.1-5.5 <br />late.: <br />PRIVACY NOTICE: The telephone 11111�������II���il numbers of the parties an this form are II ll <br />confidential according to IC 6-1.1-5,5- 111 <br />� illi1111R <br />3(d)- <br />Parcel Numbers Show addoenal parcels on separate sheet if necessary Par cr Pa <br />O � P P rY) .°.creage or Lot Size <br />JJJ1 °I 1JJJ� Ji lJJ!_I i JJJJJJ ___J J J-JJr i J <br />JJJ_�JJJ JJJJ JJ J JJJJJJJ JJJJ'-JJ � <br />Address <br />A of Parcels f <br />1134 Georgiana JJJ <br />City, Town, or Post Office ( State ZIP Code <br />1 South Bend I IJ_N J 6 1'6 �JJ JJJJ <br />Tax Billing Address (if other than property address) <br />803 Lincoln Way West <br />City, Town, or Post Office <br />State <br />ZIP <br />South Bend - -- - - -- -- <br />I f r� <br />{Code <br />_J6�J__J <br />_I <br />JJJJ <br />Lot N and Vacant Alley N & ADJ Hartman's ana NlIlIer's <br />72-- <br />identify all condiiionslitems that apply i NOTE: If items 12-21 apply, filers are not subject to disclosure <br />Ifiling fee, <br />01-Buyer is an adjacent property owner <br />J2-Vacant Land <br />O3-Exchange for other real property ("Trade") <br />O4-Seller Paid Points; amount if applicable <br />O5-change planned in the primary use of the property? Describe in <br />special circumstances. <br />O12-Secunty interest documents such as mortgages or trust deeds. <br />O13-Leases less than 90 years <br />O14-Document resulting from foreclosure, or express <br />threat of foreclosure, divorce court order, condemnation, <br />probate or other judicial proceedings. <br />a15-Agreements and other documents for <br />mergers, consolidations, and incorporations <br />O16-Quitclaim deeds not serving as a source of title, <br />O17-Cocuments involving the partition of land between <br />tenants in common, joint tenants, or tenants by the <br />entirety. <br />OD18-Transfer to a charity, not -for -profit or government <br />institution <br />O19-Transfer for no or discounted consideration, or gift <br />0 20-Rerecording to correct prior recorded document <br />O21-Easements, Right-of-way grants <br />Contract Date (dAM)CDJYYYy) Sales Price <br />Describe any unusual or specal circumstances related to this sale, including the specification of any less -than -complete ownership interest and Terms of seller financing. <br />I ' <br />O6-Existence of family or business relationship between buyer and seller <br />O7- Land Contract Dated: <br />a8-Personal property included in transfer; amount if applicable <br />$0.0,0 <br />O9- Significant physical changes to property between March 1 and date of sale <br />(D 10- Non -Warranty deed; s pecify type Quit Claim <br />O11- Partial interest Describe in special circumstances. <br />)11 <br />