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I <br />SALES DISCLOSURE FORM <br />Stale Form 46021 (R4f9-04) PRIVACY NOTICE: The telephone r r J r <br />numbers of the parties an this form <br />1-5.5 re <br />Prescribed by Department of Local Government Financeconfidential a according to JC 6-1 <br />Finance 1 f f rf 1f 1 f 1 f f 1 1 f 1 <br />Pursuant to IC 5-1.1-5,5 <br />3(d). <br />Parcel Numhet(s) (Show additional parcels on separate sheet If necessary.) Acreage or Lot SPart of Pa <br />Size (si <br />3 JJJJ �J JJJJJJJJJJ JJJJL�JP <br />JJJ JJJJ JJJ IJJJJJJJ JJJJ-JJ 0 <br />JJ JJJJJJJJJJJJJJJJJJJ JJJ U-] 0 <br />Address p of Parcels <br />I38 East Dayton �� f <br />City, Town, or Post Office State ZIP Code <br />South Bend IN 466 1]3] JJJJ <br />Tax Billing Address (if other than property address) <br />ton <br />j City, Town, or Post Office Stale ZIP Code <br />J � <br />i South Bend _ I1NJ 4J 6 <br />J 1j3 JJJ <br />Lot 48 of Dubail's 3rd Addition <br />Identify all conditionslitems that apply <br />O1-Buyer is an adjacent property owner <br />0 2-Vacant Land <br />0 3-Exchange for other real property ("Trada") <br />0 4JSelter�Paid <br />�Points; amount if applicable <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 />• <br />fi-Existence of family or business relationship between buyer and seller <br />O7- Land Contract Dated: <br />0 8-Personal <br />prperty included in transfer, amount if applicable <br />0 9- Significant physical changes to property between March 1 and date of safe <br />0 10- Non -warranty deed; specify type u I t Claim <br />O11-Partial interest Describe in speciaf circumstances. <br />O12-Secudry Interest documents such as mortgages or trust deeds. <br />O13-Leases less than 90 years <br />Q14-Document resufUng from foreclosure, or express <br />threat of foreclosure, divorce court order, condemnation, <br />probate or other Judicial proceedings. <br />a15-Agreements and other documents for <br />mergers, consolldations, and incorporations <br />16-0uitclairn deeds not serving as a source of title <br />O17-Documents involving She 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 of discounted consideration, or gift <br />O20-Rerecording to correct prior recorded document <br />O21-Easements, Rlght-of-way grants <br />Contract Date (MMIDDIYYYY) Sales Price <br />Describe any unusual or special circumstances related to this sale, including the speafication of an IesJJ�m lele ownership and terms of seller financing. <br />Y p P 9 <br />