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INDIANA SALES DISCLOSURE FORM SDF: ID: <br />1'Ai12T�2.�:co'UlvrY`5scssoR'�" <br />Page 3 <br />The county assessor must verify and compfete items I through 14 and scamp the sales disclosure form before sending to the auditor: <br />L Property Z. AVLand 3.Avimprovemeor 4. Value ofpersonal 5. AV Total <br />Pro c G. Property 7. Neighborhood H. Tex D(s trlct <br />A) Class Code Code 9.Acreage <br />B.) <br />Assessor Stamp 10. Identify physical changes to property between March 1 and YES NO CONDITION <br />date ofsale. <br />❑ ❑ 11. Is form Completed? <br />❑ ❑ 12. Sales Fee required? <br />13. Date of sale (MM/DD/yyry); <br />14. Date form received (mm/oD/YYYY): <br />I _ <br />Items 1S through III are to be com feted by the assessor when vaildat ing this sale_ <br />15. Ifapplicable, identify any additional special circumstances relating to validation of sale, — <br />PART 3 - CQUNTY AUDITOR <br />Auditor Stamp <br />T_r <br />isclosure fee amount collected: <br />ther Local Fee:otal Fee Collected: 5.Auditor receipt book number: _ <br />5. Date of transfer (wi/Do/rrvrl: <br />YES NO CONDITION <br />❑ ❑ 16. Sale valid for trending . . <br />❑ ❑. .17. Valtdatlon ofsale complete? <br />18. Validated by. <br />YES NO CONDITION <br />❑ ❑ 6. Is form completed? <br />❑ ❑ 7. Is fee collected? <br />❑ ❑ S. Attachments complete? <br />PART 4 - RECEIPT FOR STATEMENT OF CREDIT/DEDUCTION OFASSESSED:YALUATION <br />SDFID SDFDate(AfM1f/DD1yyM BuyerI - Name as appears on conveyance document <br />Parcel Number Address of Property (Number and Streer) <br />List the deductions for which the Sales DiSC10Sure Form is application: <br />City, State, and ZIP Code of Property <br />Auditor Signature Date (bI M/DD/YYM <br />A person who knowingly and intentionally falsifies value of transferred real property, or omits or falsifies any information required to be provided in <br />the sales disclosure form commits a Class C felony, <br />