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INDIANA SALES DISCLOSURE FORM <br />Page 2 <br />Seller 1 - Name or tnory as appears on deed <br />City of South Bend <br />Address <br />227 W. Jefferson Blvd. Ste 1300 <br />City, Town. or Post Office <br />State ZIP Code <br />South Bend JN 4] 6 ] 6 J 0] 1] <br />Seller 2 - Name or Entity as appears on deed <br />Address <br />City, Town, or Post Once State ZIP Code <br />JJJ <br />- JJ JJJJJ - JJJJ' <br />Title Com any N e (if applicable) Tiee Company Phone <br />JJJ - J__LJ JJJ <br />1 - Name or Entity as appears on deed <br />Paul Read S t- <br />Will this property be the <br />. <br />buyer's primary <br />Address <br />residence? �No <br />0 Yes <br />136 'B. Da ton <br />City, Town, or Post Office <br />Stale <br />ZIP Code <br />I]J <br />4JJ <br />6J� <br />-JJJ <br />South Bend <br />3J <br />Buyer 2 - Name or Entity as appears an deed <br />Address <br />City, Town, or Post Office Slaty <br />ZIP coca <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 accordance with IC 6-1.1.5.5, "Real Property Sales Disclosure Act". <br />Signature of Seller J—� Signature.of-Buyer• <br />/ <br />Seller IJ 4i I ! <br />MMlODNYY) C'0G (M1/0DNYY1`) %I 0 O <br />1 <br />Seller Phone Buyer Phone <br />JiA 3U - -51 _� _�.J JJ JJ -JJJ <br />(L "� County assessor or other assessing otfical must verify and complete the (allowing information: <br />OSignificant physical changes to property between March 1 and date of sale <br />9 r';;•:P L! 1J AV LAND f Property class <br />Cb <br />r -J use code <br />rf �U �`lJ Taxing District tDLGF asstgnec <br />ra O AV 1MPV —1J <br />`� <br />Completion No <br />`J Date Entered in Transfer Book � AV TOTAL O Valid Sale <br />F —1� J <br />/ �! —I I 1 1 JJJJJJJJ—JJ-]NEIGHBORHOOD CODE <br />