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I <br />14 <br />�N��n4=F SALES DISCLOSURE FORM <br />i ��•, Slate Form 46021 (R4M-04) PRIVACY NOTICE: The telephone <br />�%{ •. \o numbers of the parties on this form are <br />„� Prescribed byNpartmentofLocalGovernmentFinance confidential according to IC 6-1.1-5.5- 1111111111lII�11111IIlllIIIIIIIll11I II <br />V J Pursuant to IC 6-1.15.5 <br />ra16 <br />Part of Pem <br />Parcel Number(s) (Show additional parcels on separate sheet if necessary.) Acreage or Lot Size (spli <br />JJ - 3 J�� I�JJJ JJJJJJ JJJJJ • <br />JJJJJJJJJJJJJJJJJJJJJ JJJJ•JJJ � <br />JJJJJJJJJJJJJJJJJJJJJ JJJJJJJ <br />Address of Parcels <br />222 W. Ireland Rd. J E <br />City, Town, or Post Off ce Slate ZIP Code <br />South Send J J JJ �JJ 6 ��JJ <br />Tax Billing Address (if other than property address) <br />1316 County -City Bldg, 227 W. Jefferson Blvd. <br />City, Town, or Post Office <br />State <br />J� <br />ZIP Code <br />JJ <br />JJJJ <br />South Bend <br />JLl <br />Legal Description <br />see attached <br />identify all conditionslitems that apply <br />a1-Buyer is an adjacent property owner <br />O2-Vacant Land <br />O3-Exchange for other real property ("Trade") <br />O4-Seller Paid Points; amount if applicable <br />sn I 1 I f <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 />filinca fee. <br />O6-Existence of family or business relationship between buyer and seller <br />O7- Land contract Dated: <br />a8-Personal property included in transfer; amount if applicable <br />J TJ JJ <br />O9- Significant physical changes to property between March 1 and date of sale <br />O10- Non -Warranty deed; specify type <br />O111- Partial Interest. Describe in special circumstances. <br />O12-Secudty Interest documents such as mortgages or trust deed$. <br />a13-Leases less than 90 years <br />14-Document resulting from foreclosure, or express <br />threat of foreclosure, divorce court order, condemnation, <br />probate or other judicial proceedings. <br />O15-Agreements and other documents for <br />mergers, consolidations, and incorporations <br />O16-Ouitclalm deeds not serving as a source of title <br />O17-Documents Involving the partition of land between <br />tenants in common, joint tenants, or tenants by the <br />entirety. <br />O18-Transfer to a charity, not -for -profit or government <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 Dale (MM/DDfYYYY) Sales Price <br />' F?—To U S $ <br />Describe any unusual or special circumstances related to this sale, including the spedricalion of any less -than -complete ownership interest and terms of seller financing. <br />Q f t of land for highway purposes. Price includes land, land improvements, and cost-to- <br />Saletrurchase of 4,85 square ee <br />cure items. <br />I <br />