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t <br />tNt iT"_ra SALES DISCLOSURE FORM , <br />okl% �o Slate Form46021 (R4f&04) PRIVACY NOTICE: The telephone <br />y confidential the <br />cord g too[this C 6-1.1r5 5 re I 11EI 11111111111111111111111111111111 <br />a• Prescribed b Department of Local Government Finance <br />Pursuant io IC 6-7 1-S 5 <br />3(d). <br />Parcel Number(s) {Show additional parcels on separate sheet if necessa Part of part <br />JJJJJJJ JJJJJJ_ JJJJJ JJJJ'JJJ <br />I-Iiiii-Lij U-iiiiiii JJ J-1-1-1-1- JJ_� JJJ O <br />ii-i-li-iJJJJJJJJJJJJJJJ JJJJ'JJJ a <br />Address !! of Parcels <br />51933 Orange Road <br />City, Town, or Post Office State I ZIP Code I J <br />South Bend I I N 4 j 6 1 6 2 1 8 '- J_JJ_J <br />Tax 8111ino Address (if other than nroaertv address) <br />City, Town, or Post Office State ZIP Code <br />_J JJ JJJJ - JJJJ <br />See Attached Exhibit "A" <br />Identify all conditionslitems that apply <br />• 1-13uyer Is an adjacent property owner <br />. 2-Vacant Land <br />J3-Exchange for other real property ("Trade") <br />O4-Seller Paid Paints; amount If applicable <br />$JOJJJJ <br />O5-Change planned In the primary use of the property? Describe In <br />special circumstances. <br />NOTE: If items 12-21 apply, filers are not subject to disclosure <br />filing fee. <br />O6-Existence of family or business refationshlp between buyer and seller <br />0 7- Land Contract Dated; <br />0 8-Personal <br />�propertmy Included In transfer,, amount If appllcable <br />$ F].I�L�J L l�J <br />O9- Significant physical changes to property between March 1 and date of sale <br />O10- Non -Warranty deed; specify type <br />O11- Partial interest. Describe In special circumstances. <br />O12-Security Interest documents such as mortgages ortrust deeds, <br />0 13-Leases less than 90 years <br />14-Document resulting from foreclosure, or express <br />threat of foreclosure, divorce court order, condemnatlon, <br />probate or other judicial proceedings. <br />0 15-Agreements and other documents for <br />mergers, consolidations, and incorporatlons <br />O16.Quitclaim deeds not serving as a source of title <br />n17-Documents Involving the partition of ?and between <br />tenants In common, joint tenants, or tenants by the <br />entirety. <br />JJ 0 18-Transfer to a charity, not -for -profit or govemment <br />�� Institution <br />O19-Transfer for no or discounted conslderatlon, orgift <br />0 20-Rerecording to correct prior recorded document <br />O21-Easements, Right-of-way grants <br />Contract Date (MWDDIYYYY) Sales Price <br />oo �JJJ.JJ <br />Describe any unusual or special circumstances related to this sale. Including the specification of any less -than -comp <br />Fee Simple Right -of -Way for Road Construction <br />Mo© <br />interest and terms of seller <br />