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1 <br />City of South Bend <br />VACANT & ABANDONED PROPERTY DONATION FORM <br />Please write clearly. Applications that are not legible will not be processed. If you have any questions about the application or <br />process please contact Erin Michaels at (574)235-5931 or emichaels@southbendin.gov. <br />Submit completed donation form to: City of South Bend Department of Community Investment <br />Attn: Erin Michaels <br />227 W. Jefferson Blvd, Suite 1400S <br />South Bend, IN 46601 <br />Contact Information for Owner of Record / Potential Donor: <br />Owner of Record / Donor(s): ______________________________________________________ <br />Address: ______________________________________________________________________ <br />City: _________________________ State: ______ Zip: _________ <br />Home Phone ( ) _____-_______ Work Phone ( ) _____-_______ Cell Phone ( ) _____-_______ <br />Email Address: ________________________________________________________________ <br />Property Information: <br />Property Address: ________________________________________________ South Bend, IN, 466______ <br />Does Applicant Own Property? Yes ____ No ____ If yes, for how long? ________________ <br />Does the property have a structure on it (i.e. house, garage, shed)? Yes ____ (describe_____________) No ____ <br />If it has a house, is it occupied? Yes ____ No ____ <br />How was the property acquired? ____ Conventional/Private Sale ____ Tax Sale/Commissioner Sale <br />_____Other (explain :____________________________________________________) <br />Is the property current on property taxes? Yes ____ No ____ Unsure ____ <br />Is there an unpaid lien against the property (such as mortgages, federal tax lien, etc.)? Yes ____ No ____ <br />If yes, describe _____________________________________ <br />Does the property have current / cited code violations? Yes ____ No ____ Unsure ____ <br />Does the property have an affirmed demolition order through the City of South Bend’s Dept. of Code <br />Enforcement? Yes ____ No ____ Unsure ____ <br />Does the proposed donation include a cash donation to assist with maintenance, repairs and/or demolition? <br />Yes ____ No ____ If yes, in what amount? $________________