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I <br />SALES DISCLOSURE FORM <br />State Form 46021 (R419-04) <br />W: <br />Presrnbed by Department of Local Government Finance <br />Pursuant to IC 6.1 1.5.5 <br />i8te ~ <br />numbers <br />PRIVACY the <br />cord according tonIC 6S1f 1 5 5 re IIIII IIIII lllll IIIII Illlf f fllllllll lillllll <br />3(d). <br />Pan or Parr, <br />Parcel Number(s) (Show addifienal parcels on separate sheet if necessary.) Acreage or Lot Size (spl, <br />J81J� 9 5 J-3131 -1-1 J_JJ JJ—JJJ O <br />U U _LJJJJJJJ IJJJJJJJJ JJJJJ <br />JJJ_!UJ_I_I� ,' I_I _I�_'JJJJJ_JJJ J_JJJJJ � <br />Address <br />9 of Parcels <br />1247 Howard <br />JJJ <br />City, Town, or Post Office <br />State ZIP Code <br />South Bend <br />I IN I �JJJJ �JJJ <br />Tax 8itflna Address (if other than crooerty address) <br />JAI 402 E. South Street , <br />City, Town, or Post Office State ZIP Code <br />L South Bend J­_] ] J.tiJ_JJ IJJJ <br />Vacant Land adjacent to 1241 Howard Street/Lot #29 Talbot's Plat <br />Identify all conditionslitems that apply ;NOTE: If items 12-21 apply, filers are not subject to disclosure <br />filing fee. <br />O1-Buyer is an adjacent property owner <br />2-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 />O6-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 />s F1 , FT J <br />O9- Significant physical changes to property between March 1 and date of sale <br />a 10- Non -Warranty deed; specify type Quit C l a i M <br />O11- Partial interest Describe in special circumstances. <br />O12-Security interest documents such as mortgages or trust deeds. <br />0 13-Leases less than 90 years <br />0 14-Document resulting from foreclosure, or express <br />threat of foreclosure, divorce court order, condemnation, <br />probate or otherjudicial proceedings. <br />O15-Agreements and other documents for <br />mergers, consolidations, and incorporations <br />O16-Quitclaim deeds not serving as a source of tltle <br />O17-Documents involving the partition of land between <br />tenants in common, joint tenants, or tenants by the <br />entirety. <br />n 18-Transfer to a charity, not-for-prord or government <br />institution <br />O19-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 (MMIDD/YYYY) Sales Pnce <br />I <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 financing. <br />