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DI' INDIANA SALES DISCLOSURE FORM Pacje 2 <br />Seiler I . Name or Entity as appears on deed <br />f City of South Bend <br />Address <br />227 West_ Jefferson Blvd., Ste 1300 <br />City, Town, or Post Office Stal <br />e ZIP Code _ I <br />South Bend, <br />Seiler 2 -Name or Entity as appears on deed <br />Address <br />City, Town, or Post Office State ZIP Code <br />Title Company Name (if applicable) Tille Company Phone <br />1 - Name or Entity as appears on deed <br />South Bend Heritage Foundation wiillIris property bethe <br />buyer's primary <br />Address residence? <br />803 Lincoln Way West 0Yes 0No <br />City, Tawn, or Post Office Stale f ZIP Code I I I + f <br />South _Bend <br />Buyer 2. Name or Entity as appears on deed <br />Address <br />City, Town, or Post O ite Slate ZIP Code <br />1- - ` _ - _-JJ JJ�JJ <br />Under penalties of perjury, I hereby certify that this Sales Oisclosure, 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 5-1.15.5, 'Real Property Sales Disclosure Act", <br />Signature of Seiler <br />( lwel r ign Dot, 1 I <br />Moon^rw D �I O D G <br />Seiler Phone <br />��_�-zd3 l-JJ-6ki <br />ature of <br />Buyer Sign DatF. <br />(MMraorvYYv) <br />Buyer Phone <br />J 1J - J_J i IJJ <br />{{{� County Assessor or other assessing offical must verify and complete the following information: <br />j O Significant physical changes to property between March i and date of sale <br />AUDITOR'S f- E STAMP � � _j_� Property class <br />AV LAND use code <br />Taxing Olsldct (OLGF assign.d <br />j.177 AV IMPV J <br />Completion O Yes O No f <br />4V TOTAL Q Valid sale <br />Cale Entered in Transfer Book 1� f <br />�_J—IJ��i_JIJ� �_j_J <br />NEIGHBORHOOD CODE <br />