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RECORDED ON
07-23-2002 1:39:37
TERRI J. RETHLARE
ST. JOSEPH COUNTY
RECORDER
REC. FEE: 14.00
PAGES: 1
Mail Deed To: Mail Tax Bills To:
AUDITOR'S RECORD
South Bend Heritage Foundation
914 Lincoln Way West Transfer No.
South Bend, IN 46616 Taxing Unit S
Date —7 • 3>- 3 Gl�
Key No. 18-1044-1883
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QUIT -CLAIM DEED
City of South Bend, Indiana
the Grantor
Releases and Quit -Claims to South Bend Heritage Foundation
the Grantee
for and in consideration of One Dollar ($1.00) and other good and valuable consideration
the receipt of which is hereby acknowledged, Real Estate in St. Joseph County, in the State of Indiana,
described as follows:
Lot Numbered Eighty-one (81) in Commissioner's Subdivision of the North part of Bank
Out Lot Numbered Seventy-nine (79) of the second Plat of Out Lots of the Town, now
City of South Bend, platted by the State Bank of Indiana, and more commonly known as
1227 West Colfax Avenue.
Signed and dated on
CITY OF SOUTH BEND, INDIANA
i
Stephen J. Luec�
C*ettJ.
STATE OF INDIANA, ST. JOSEPH COUNTY, ss:
Before me, a Notary Public in and for said County and State, personally appeared Stephen J.
Luecke and Loretta J. Duda, Mayor and City Clerk, respectively, of the City of South Bend, Indiana, and
acknowledge the execution of the foregoing deed on .2002.
My Commission Expires: tRcsi�
n M.y Notary Public
12-• lg' 0a ginSl-.,�osGfh County, lnAiax-La
Prepared by Thomas L. Bodnar, Assistant City Attorney, 1400 County -City Building, South Bend, IN 46601.
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Slate Form 46021 (R311-00)
Approved by State Board of Accounts, 2000
Prescribed by the State Board of Tax Commissioners, 1999
Pursuant to IC 6-1.1.5.5
r ,
name(s)
M.1.(s)
Last name(s)
City of South Bend, Indiana
JFirst
Address (number and street)
Primary residence?
1300 County -City Bldg.
El Yes ❑No
City, Town or Post Office
State
ZIP code
South Bend
IN
46601
s)
M.I.(s)
Last name(s)
Bend Heritage Foundation
mber and street)
Primary residence?
' incolnway West
Yes ❑No
or Post Office
Ltaxtbills
Statel N
ZIP code
46601
Bend
ills and notices to thls address?
If no, provide mailing address (number and street, city, state, ZIP code)
No
Street address
1227 West Colfax
City Town or Post Office StIN ZIP code 46616
youth Bend
' County South Bend YtnsfF�jE
t ag e School Corporation Name
EXEMPT TRANSACTIONS (see instructions on reverse side)
Exempt Transaction? If yes, specify the number of the exemption. (see 'Exempt Transactions" on reverse side)
❑ Yes ❑ No
SALES INFORMATION
1. TotaI sales price $ 1 .00
DATE OF SALE
Month I Day I Year 12. Seller paid points $
1 I I I I I 13. Net sales price (fine I minus line 2) $ 1. 0 0
T Check ALL of the following conditions that apply to this sale.
❑ Transfer of entire parcel ❑ Purchase of adjoining land ❑ Vacant land Cl Exchange for other real property ("Trade')
❑ Seller provided financing ❑ Mobile home ❑ Condominium Cl Split(s)
❑ Existence of family or business relationship between buyer and seller ❑ Personal property included In transfer (PONATal1 )
Describe any unusual or special circumstances related to this sale, Including the specification of any a s-tha C��Tnpldtm o8-nership In t, and
the terms of any seller financing. N a-U
a s.. M N V
r-- a ' 0 o A
o 'rt ti
County Auditor must verify and complete the following Information:
❑ Buyer and Seller information 0 Sales price
❑ Address of property transferred 0 Conditions of sale
❑ Dale of sale/transfer
County Assessor must verify and complete the following Information:
❑ Significant physical changes to property between March 1 and dale of sale
❑ Current property record card attached
❑ Parcel I Key number
❑ School corporation number_
❑ Warranty deed? ❑ YES ❑ NO
ASSESSED VALUE (AV) INFORMATION
AV LAND $
AV IMPROVEMENT(S) $
❑Property class /use code
AV TOTAL $
Tha parties to a real property conveyance are required to rile this form and attest in writing and under the penalties of perjury that the Information contained
herein is true and correct. A person who knowingly and intentionally falsifies or omits any information required on this form commits a Class A Infraction.
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 6-1.1-5.5, "Real Property Sales Disclosure Act."
Sion -attire of Seller or reoresentative Telephone number Dale signed (month da e
574-235-9241
Telephone number
fly
� ar)
Signature of Buyer or represen
Dale signed (month, day, year)
Instructions for Completing the Sales Disclosure Form
Indiana law requires a sales disclosure form to be completed when a conveyance document (see definition below for use
of this form) is filed with the county auditor. The county auditor may not accept a conveyance document if (1) the sales
disclosure form is not included with the conveyance document; or (2) the sales disclosure form is incomplete. A person
filing a sales disclosure form shall pay a fee of five dollars ($5.00) to the county auditor.
Part 1: Buyer, Seller, Exempt Transaction and Sales Information Section
Buyer and Seller Information. The full first name, middle initial, and last name is requested from the buyer and seller,
Each transferor and transferee must provide their current address (use additional sheets if necessary). Either the buyer or
the seller should provide the full address, county, township, and school corporation for the property to be transferred.
The buyer and seller must also indicate if the property is the primary residence by checking the appropriate box.
Sales Information. The date of the property transfer is to be printed in the space provided. The selling price of the
property should be listed in line 1 of the "Sales Information." If the seller paid any points or fees to facilitate the transaction,
the dollar value of those is requested in line 2. The Net Sales Price is the dollar amount of line 1 less line 2.
Exempt Transaction. If the transaction meets one of the conditions listed below, please indicate in the "Exempt
Transaction" section that the transaction is exempt and provide the reason number. Data in the "Sales Information" section
does not have to be completed for an exempt transaction.
1. Mortgages and other security interest documents
2. Leases
3. A document resulting from a foreclosure or express threat of foreclosure, divorce, court order, condemnation, probate
or other judicial proceedings (examples include sheriff's deed or trustee's deed)
4. Transfer to / from a charity, non-profit or government institution
5. Agreements and other documents for mergers, consolidations and incorporations
6. Quitclaim deeds not serving as a source of title
7. Transfer for no or discounted consideration, or gift
8. Documents involving the partition of land
9. Re-recording to correct prior recorded document
10. Easements, Right-of-way grants
11, Contract sale or deeds issued at front-end of sale or upon completion of contract sale
Sales Condition. For all the conditions that apply to the sale, the appropriate box or boxes must be checked. At least
one (1) of the boxes in this section must be checked. With regard to personal property (see below), the buyer or seller
must enter an estimated value of the personal property included in -the sale. Any unusual or special conditions of the sale
that may affect the sales price or terms of the sales agreement should be described.
Part 2: County Auditor Section
The county auditor is responsible for verifying that the buyer and seller have completed Part 1 of the safes disclosure
form. If Part 1 of the sales disclosure form is complete, the county auditor must enter the parcel number for the property
being transferred, School Corporation Name, and indicate whether the transfer involves a warranty deed. In the event that
the buyer and / or seller fails to complete all or portions of Part 1 of the sales disclosure form, the county auditor may not
accept a conveyance document for the property being transferred. In addition, the county auditor is to verity that the buyer
and seller have signed the sales disclosure form (see Part 4: Signature and Verification Section).
Part 3: County Assessor Section
The county assessor is responsible for determining whether or not significant physical changes have been made to the
property between March 1 and the date of sale. If so, the county assessor should check the appropriate box. An example
of this would be a recently constructed house or building. After attaching the current property record, the county assessor
must check the indicated box and enter the current property class code. Based on the current property record card, the
county assessor must enter the current assessed value (AV) for the land, improvements and the total AV in the space
provided. (NOTE: In Marion County, township assessors are responsible for this section).
Part 4: Signature and Verification Section
The seller, buyer, or their representatives must sign one (1) sales disclosure form, or if the parties do not agree on the
information to be included on the completed form, each party must sign and file a separate form. If anyone other than the
buyer, seller, or an attorney is filling out the form (e.g.: bank official, title company official, or realtor), a Power of Attorney
must be completed and attached. A person who knowingly and intentionally falsifies or omits any information required
on this form commits a Class A infraction.
Definitions
Conveyance document means any document, deed, quitclaim deed serving as a source of title, or other document presented
for recording, that purports to transfer a real property interest for valuable consideration.
Personal property - For residential sales, personal property includes items that are not attached (built-in) to the home, This
includes, but is not limited to items such as washers, dryers, drapes, stoves, refrigerators, and dishwashers. For agricultural
sales, personal property items may include grain, livestock, and farm machinery and equipment. For commercial and
industrial sales, personal property includes inventories and depreciable assets.