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Home My WebLink Aboutsdf20b (003)Final_08_07_2020 PRIVACY NOTICE: The telephone numbers and Social Security numbers of the parties SALES DISCLOSURE FORM State Form 46021 (R9/7‐09) nt of Local Government Finance Prescribed by Departme Pursuant to IC 6‐1.1‐5.5 on this form are confidential according to IC 61.15.53(d). SDF ID County Year Unique ID SDF Date: __________________________ PART 1 – To be completed by BUYER/GRANTEE and SELLER/GRANTOR A. PROPERTY TRANSFERRED – MUST BE CONVEYED ON A SINGLE CONVEYANCE DOCUMENT 1. Property Number Ch ck box if applicable to parcel e 5. Complete Address of Property 6. Complete Tax Billing Address (if different from property address) A.) F 2. Split F 3. Land F 4. Improvement 7. Legal Description of Parcel A: B.) F 2. Split F 3. Land F 4. Improvement 7. Legal Description of Parcel B: B. CONDITIONS – IDENTIFY ALL THAT APPLY C. SALES DATA – DISCLOSE VALUE OF ITEMS LISTED IN TABLE B, ITEMS 1‐15 If lies, filer is subject to disclosure and a disclosure filing fee. condition 1 app 1. Conveyance date (MM/DD/YYYY): _________________________________________________ __ 2. Total number of parcels: _____________________________________________________ 3. 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. ______________________________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________ YES NO CONDITION 1. A transfer of real property interest for consideration. F F cent property owner. F F valuable 2. Buyer is an adja F F 3. Vacant land. F F real property ("Trade"). 4. Exchange for other F F 5. Seller paid points. (Provide the value Table C Item 12.) F F 6. Change planned in the primary use of the property? (Describe in special circumstances in Table C Item 3.) F F r ationship ete 7. Existence of family or business el between buyer and seller. (Compl Table C Item 4.) F F _______________ _____________ 8. Land contract. Contract term (YY): _________ and contract date (MM/DD/YYYY): _________________ F F ue 9. Personal property included in transfer. (Provide the val Table C Item 5.) F F s to property between March 1 s in Table C Item 3.) 10. Physical change and date of sale. F s in Table C Item 3.) (Describe in special circumstance F 11. Partial interest. (Describe in special circumstance F F 12. Easements or right‐of‐way grants. YES CONDITION NO F F 4. Family or business relationship existing between buyer and seller? __ Amount of discount: $______________________________________ Disclose actual value in money, property, a service, an agreement, or other consideration. If conditions 1315 apply, filers are subject to disclosure, but no disclosure filing fee. 5. Estimated value of personal property: $ YES NO CONDITION 6. Sales price: $ F F 13. Document for compulsory transactions as a result of foreclosure or express threat of , foreclosure, divorce, court order, judgment condemnation, or probate. F F 14. Documents involving the partition of land between tenants in common, joint tenants, or tenants by the entirety. F F 15. Transfer to a charity, not‐for‐profit organization, or government. YES CONDITION NO F F 7. Is the seller financing sale? If yes, answer questions (8‐13). F F nally liable for loan? 8. Is buyer/borrower perso s a mortgage loan? F F 9. Is thi 10. Amount of loan: $ 11. Interest rate: % 12. Amount in points: $ 13. Amortization period: INDIANA SALES DISCLOSURE FORM SDF ID: _________________________________ Page 2 D. PREPARER ______________________________________________________________________________________________ ______________________________________________________________________________________________ Preparer of the Sales Disclosure Form Title ______________________________________________________________________________________________ ______________________________________________________________________________________________ Address (Number and Street) Company ______________________________________________________________________________________________ ______________________________________________________________________________________________ Telephone N mber Email City, State, and ZIP Code u E. SELLER(S)/GRANTOR(S) ______________________________________________________________________________________________ Seller 1 Name as appears on conveyance document ______________________________________________________________________________________________ Address (Number and Street) ______________________________________________________________________________________________ City, State, and ZIP Code ______________________________________________________________________________________________ Telephone Number Email ______________________________________________________________________________________________ Seller 2 Name as appears on conveyance document ______________________________________________________________________________________________ Address (Number and Street) ______________________________________________________________________________________________ City, State, and ZIP Code ______________________________________________________________________________________________ Telephone Number Email Under penalties of perjury, I hereby certify that this Sales Disclosure, to the best of my knowledge and belief, is true, correct ceand complete as required by law, and is prepared in accordan with IC 61.15.5, "Real Property Sales Disclosure Act". ______________________________________________________________________________________________ Signature of Seller ______________________________________________________________________________________________ Printed Name of Seller Sign Date (MM/DD/YYYY) ___________________________________________________________________ Printed Name of Seller ______________________________________________________________________________________________ Signature of Seller ___________________________ Sign Date (MM/DD/YYYY) F. BUYER(S)/GRANTEE(S) – APPLICATION FOR PROPERTY TAX DEDUCTIONS– IDENTIFY ALL ITEMS THAT APPLY ______________________________________________________________________________________________ Buyer 1 Name as appears on conveyance document ______________________________________________________________________________________________ Address (Number and Street) ______________________________________________________________________________________________ City, State, and ZIP Code ______________________________________________________________________________________________ Telephone Number Email ______________________________________________________________________________________________ Buyer 2 Name as appears on conveyance document ______________________________________________________________________________________________ Address (Number and Street) ______________________________________________________________________________________________ City, State, and ZIP Code ______________________________________________________________________________________________ Telephone Number Email T S I OSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUHE ALES D SCL CTIONS FOR TH PR PERTY THAT APPLY. IS O . IDENTIFY ALL OF THOSE YES NO CONDITION YES CONDITION NO F F 1. Will this property be the buyer's primary residence? Provide complete address of primary residence, including county: ______________________________________________________________________________________________ Address (Number and Street) ____ ______ ___ City, State ZIP Code _ ___ _ ____________________________________________________________________________ County F F 2. Does the buyer have a homestead in Indiana to be vacated for this residence? If yes, provide complete address of residence being vacated, including county: ______________________________________________________________________________________________ Address (Number and Street) ______________________________________________________________________________________________ City, State ZIP Code County 3. Homestead F F /Cooling System F F 4. Solar Energy Heating F F 5. Wind Power Device F F 6. Hydroelectric Power Device F F 7. Geothermal Energy Heating/Cooling Device F F 8. Is this property a residential rental property? F F 9. Would you like to receive tax statements for this property via e‐mail? (Provide contact information below. Please see instructions for more information. Not available in all counties.) ___________________________________________________________________________________________ _ Primary property owner contact name Email Under penalties of perjury, I hereby certify that this Sales Disclosure, to the best of my knowledge and belief, is true, correct and complete as required by law, and is prepared in accordance with IC 61.15.5, "Real Property Sales Disclosure Act". (Note: Spouse information, Social Security and Driver’s License/Other numbers are not necessary if no Homestead Deduction is being filed.) ______________________________________________________________________________________________ Signature of Buyer1 ______________________________________________________________________________________________ Printed Legal Name of Buyer 1 Sign Date (MM/DD/YYYY) ______________________________________________________________________________________________ Last 5 digits of Buyer 1 Driver’s State Last 5 Digits of Social Security Number License/ID/Other Number ______________________________________________________________________________________________ Signature of Buyer2/Spouse ______________________________________________________________________________________________ Printed Legal Name of Buyer 2/Spouse Sign Date (MM/DD/YYYY) ______________________________________________________________________________________________ Last 5 digits of Buyer 2/Spouse Driver’s State Last 5 Digits of Social Security Number License/ID/Other Number INDIANA SALES DISCLOSURE FORM SDF ID: _________________________________ Page 3 PART 2 ‐ COUNTY ASSESSOR The county assessor must verify and complete items 1 through 14 and stamp the sales disclosure form before sending to the auditor: 1. Property 2. AV Land 3. AV Improvement 4. Value of Personal Property 5. AV Total 6. Property Class Code 7. Neighborhood Code 8. Tax District 9. Acreage A.) B.) Assessor Stamp 10. Identify physical changes to property between March 1 and date of sale. _____________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ Y CONDITION ES NO 11. Is form completed? tate sales f required? F F F F 12. S ee ): 13. Date of sale (MM/DD/YYYY ________________________________________________ 14. Date form received (MM/DD/YYYY): ________________________________________________ Items 15 through 18 are to be completed by the assessor when validating this sale: 15. If applicable, identify any additional special circumstances relating to validation of sale. _________________________________ __________________________________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________________________________ Y ES NO CONDITION 16. Sale valid for trending? F F F F 17. Validation of sale complete? 18. Validated by: ______________________________ PART 3 ‐ COUNTY AUDITOR Auditor Stamp 1. Disclosure fee amount collected: $__________________________________ 2. Other Local Fee: $____________________________________________________ 3. Total Fee Collected: $_________________________________________________ ook numb4. Auditor receipt b er: ______________________________________ f transfer (MM/DD/YYYY): _______________________________________ 5. Date o Y CONDITION ES NO 6. Is form completed? F F F F 7. Is state fee collected? F F 8. Attachments complete? _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ PART 4 – RECEIPT FOR STATEMENT OF DEDUCTION OF ASSESSED VALUATION ______________________________________________________________________________________________ SDF ID SDF Date (MM/DD/YYYY) ______________________________________________________________________________________________ Parcel Number ______________________________________________________________________________________________ Buyer 1 Name as appears on conveyance document ______________________________________________________________________________________________ Address of Property (Number and Street) ______________________________________________________________________________________________ City, State, and ZIP Code of Property ______________________________________________________________________________________________ Auditor Signature Date (MM/DD/YYYY) Check all that apply: F Homestead F Solar Energy F Wind Power F Hydroelectric F Geothermal F Rental Property F Electronic Statement (e‐mail)______________________________________________ A person who knowingly and intentionally falsifies value of transferred real property, or omits or falsifies any information required to be provided in the sales disclosure form commits a Class C felony.