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HomeMy WebLinkAboutProperty Donation Form 5.2.251 City of South Bend VACANT & ABANDONED PROPERTY DONATION FORM Please write clearly. Applications that are not legible will not be processed. If you have any questions about the application or process please contact Erin Michaels at (574)235-5931 or emichaels@southbendin.gov. Submit completed donation form to: City of South Bend Department of Community Investment Attn: Erin Michaels 227 W. Jefferson Blvd, Suite 1400S South Bend, IN 46601 Contact Information for Owner of Record / Potential Donor: Owner of Record / Donor(s): ______________________________________________________ Address: ______________________________________________________________________ City: _________________________ State: ______ Zip: _________ Home Phone ( ) _____-_______ Work Phone ( ) _____-_______ Cell Phone ( ) _____-_______ Email Address: ________________________________________________________________ Property Information: Property Address: ________________________________________________ South Bend, IN, 466______ Does Applicant Own Property? Yes ____ No ____ If yes, for how long? ________________ Does the property have a structure on it (i.e. house, garage, shed)? Yes ____ (describe_____________) No ____ If it has a house, is it occupied? Yes ____ No ____ How was the property acquired? ____ Conventional/Private Sale ____ Tax Sale/Commissioner Sale _____Other (explain :____________________________________________________) Is the property current on property taxes? Yes ____ No ____ Unsure ____ Is there an unpaid lien against the property (such as mortgages, federal tax lien, etc.)? Yes ____ No ____ If yes, describe _____________________________________ Does the property have current / cited code violations? Yes ____ No ____ Unsure ____ Does the property have an affirmed demolition order through the City of South Bend’s Dept. of Code Enforcement? Yes ____ No ____ Unsure ____ Does the proposed donation include a cash donation to assist with maintenance, repairs and/or demolition? Yes ____ No ____ If yes, in what amount? $________________ 2 Please provide a copy (not original) of the recorded deed that indicates the applicant is the property owner. If you do not have a copy of the recorded deed, one is available through the St. Joseph County Recorder, located on the 3rd floor of the County-City Building, 227 W. Jefferson Blvd., in downtown South Bend. For questions, the St. Joseph County Recorder can be reached at (574) 235-9525. APPLICANT’S CERTIFICATION AND AUTHORIZATION 1. I/We understand that by submitting a donation form we are requesting the City of South Bend accept my/our property at no cost to the City. 2. I/We understand that the City of South Bend has the right to accept or not accept the donation of a property based on its internal review of the property in question. 3. I/We understand that the City of South Bend cannot provide a tax deduction letter for the donation of a property. 4. I/We understand and agree that the City of South Bend will need to secure and verify documents supporting my/our request for donation. 5. I/We agree to supply the City of South Bend with all information requested and give them authorization to verify all information contained in my/our application or any other documents required in connection with this program. 6. I/We agree that should the City not have interest in accepting the donation of my/our property, the City may share provided information with other entities which may have interest in the donation. In these instances, the other entity and I/we would be responsible for reaching an agreement related to the transfer of property. 7. I/We agree that this information may be reproduced or photocopied and a copy shall be effective consent as the original signed form. All property owners listed on the deed must sign below.* _________________________________________ _______________________ Owner of Record / Donor Signature Date _________________________________________ _______________________ Owner of Record / Donor Signature Date * If the owner of record is deceased, the person(s) and/or entity with the legal authority to donate may sign the donation form, but must provide documentation of authority to sign on behalf of the deceased.