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111,.; INDIANA SALES DISCLOSURE FORM <br />Page 2 <br />Seller 1 - Name or Entity as appears on deed <br />Edsel K. Wiseman and Elizabeth R. Wiseman, Co -Trustees <br />Address -- —�" <br />24334 W, Edison Road <br />City, Town, or Post Office State ZIP Code <br />South Send I J 4 � 6 1 6 2 8 - I J f <br />Seller 2 - Name or Entity as appears on deed ---� —1 _ .1 —J ._I <br />Address <br />City, Town, or Post Office State ZIP Code ` <br />Title Company Name (if applicable) Title Company Phone <br />C-7— --- � J-1 - --i I ---, I - —i <br />Buyer 1 - Name or Enlily as appears on deed <br />The City of South Bend, State of Indiana Community & Economic Development Will this property be The <br />Address buyer's primary <br />residence? <br />E�� County -City Building, 227 W. Jefferson Boulevard I� Yes ! No <br />City, Town, or Post Office Stale ZIP Code <br />South Bend I IN� 4 Ig 6In �1 1 _ �Q I� jam„ <br />Buyer 2 - Name or Entity as appears on deed —1--1 �I�J_I <br />Address <br />City, Town, or Post Office Slate ZIP Code) i <br />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 <br />is prepared in acco/rd4itce with IC 6-1.1-5,5, " eal Pr perry Sales Disclosure Act". <br />Signature of Seller r Signature of Buyer <br />Seller Sign DateBuyer (MM/DD(ArtM/ DtIYYgn D <br />Seller Phone YY) <br />/YYYY) D (c <br />Buyer PPrione,,11 ! I <br />��� ��J J_`JJ krl <br />I <br />..-PART <br />3 - COUNTY ...WNSHIP ASSESSOR <br />County Assessor or other assessing offical must verify and complete the following Informatlow <br />0 significant <br />physical changes to property between March 1 and date <br />of sale <br />,I»rv,.;, <br />AV LAND <br />Property class! <br />1-1-1_ 1-1-1u_. ode <br />J j I AV IMPV <br />Ting Dislrid lDLGF assigned) <br />Completion Yes <br />O o <br />Date Entered in Transfer Book <br />$ <br />AV TOTAL <br />0 Valld Sale <br />M / =IU-1 <br />NEIGHBORHOOD CODE <br />A <br />