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" E c�r�TE SALES DISCLOSURE FORM <br />-` 10 Stale Form 46021 (R419-04) PRIVACY NOTICE: The telephonenumbers of f I f ! f <br />4'll Jz Pre5ubed by Department of Local Government Fnance confidential alto ache cording to IC 6-1.1on this r5.5 re II�II I I I I�I II I IIIII �I IIII III Illf IIII <br />A. 9 Pursuant to IC 6.1 t-5.5 <br />...-_ 3(d). <br />re'ie <br />Pan of Parce <br />Parcel Numbers) (Show additional parcels on separate sheet if necessary.) Acreage or Lot Size (spot <br />JJJJ 1 7 JJJJ JJJJJ <br />JJ JJJJJJ JJJ • <br />JJJJ4JJJJ.JJJJ_JJ_IJ_IJJJ JJJ_I�JJJ � <br />JJJJJJJJJJJJJJJJJJJJ JJJJ-JJ o <br />Address <br />S of Parcels <br />4411 Quality Drive <br />JJJ <br />Clty, Town. cr Post Office <br />State <br />ZIP Code <br />South Bend <br />4 <br />I� N I <br />42 1 8 <br />Tax Billing Address (if other than property address) <br />City, Town, or Post Office Stale ZIP Code <br />J -1 JJJJJ-JJJJ <br />Legal Description <br />See Attached Exhibit "A" <br />Identify all conditionslitems that apply NOTE: If items 12-21 apply, filers are not subject to disclosure <br />�filing fee. <br />• 1-Buyer Is an adjacent property owner <br />• 2-Vacant Land <br />O3-Exchange for other real property ("Trade") <br />0 4-SelJer Paid Points; amount It applicable <br />O5-Change planned In the primary use of the property? Describe in <br />special circumstances. <br />O6-Existence of family or business relationship between buyer and seller <br />0 7. Land Contract Dated: <br />0 B-Personal property Included In transfer, amount If applicable <br />❑ �JJ czJ <br />0 9- Significant physical changes to property between March 1 and date of sale <br />O10- Non -Warranty deed; specify type <br />0 11- Partial Interest. Describe In special circumstances. <br />O12-Security Interest documents such as mortgages or bust deeds. <br />0 13-Leases less than 90 years <br />14-Document resuitfng from foreclosure, or express <br />threat of foreclosure, divorce court order, condemnation, <br />probate or other judlctal proceedings. <br />0 15-Agreements and other documents for <br />mergers, consolidations, and Incorporations <br />0 16-Cultclalm deeds not serving as a source of title <br />O17-Documents Involving the parlitlon of land between <br />tenants In common, joint tenants, or tenants by the <br />entirety. <br />O18-Transfer to a charity, not -for -profit orgovemment <br />Institution <br />O19-Transfer for no or discounted consideration, or gift <br />O20-Rerecording to correct prior recorded document <br />O21-Easements, Right-of-way grants <br />Contract Date (MMIDD/YYYY) Sales Price <br />f $ FO M77 <br />Describe any unusual or special circumstances related to this sale, lncluding the specification of any less-lhan-complate ownership interest and terms of seller financing. <br />Fee Simple Right -of -Way for Road Construction <br />I <br />