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F, <br />f•'kt�1� A'�t SALES DISCLOSURE FORM <br />i{ PRIVACY NOTICE: The telephone ' x' State Farm 46021 (R6/7-06) numbers of the parties on this form <br />Prescribed by Department of Local Government Finance are confidential according to IC6-1.1- I III�I I��II Ihl� #III# II#II li#till III 1111 f#II <br />rein- _ Pursuant to IC6-1.1.5.5 5.5-3(d). <br />Parcel Number#) (Show additionl parcels on separate sheet if nece <br />Address <br />102 Dr. Martin Luther King Jr. Drive <br />City, Town, or Post Office <br />State <br />ZIP Code <br />South Bend <br />Tax Billing Address (if other than property address) <br />City, Town, o Pos fflce <br />State <br />JZIP Code <br />- <br />Legal Description <br />See the attached legal description marked as Exhibit A <br />Identify all conditions/items that apply <br />0 i-Buyer Is an adjacent property owner <br />O 2-Vacant Land <br />Q 3-Exchange for other real property ("Trade") <br />0 4-Seiler Paid Points; amount if applicable <br />S <br />0 5-Change planned In the primary use of the property? Describe In <br />special circumstances. <br />a 6-Existence of farnlly or business relationship between buyer and seller <br />Q 7-Land Contract Dated: <br />Q 8-Personal property Included In transfer; amount If applicable <br />Part of Parcel <br />Acreage or Lot Size (split) <br />I 1 10 <br /># of Parcels <br />M <br />NOTE: If items 12-21 apply, filers are not subject to disclosure <br />filing fee. <br />12-Security Interest documents such as mortgages or trust <br />deeds. <br />0 13-Leases less than go years <br />0 14-Document resulting from foreclosures, or express <br />threat of foreclosure, divorce court order, condemnation, <br />probate or other judicial proceedings. <br />Q 15-Agreements and other documents for mergers, consolidations, <br />and Incorporations <br />Q 16-quitdaim deeds not serving as a source of title <br />0 17-Documents involving the partition or land between tenants <br />j� In common, joint tenants, or tenants by the entirety. <br />J J 0 18-Transfer to a charity, not -for -profit or government <br />L� Institution. <br />(1 9-Significant physical changes to property between March I and date of sale 19-Transfer for no or discounted consideration, or girt <br />Q 10-Mon-Warranty deed; spedfy type (D 24-Rerecording to correct prior recorded document <br />0 11-Partial Interest. Describe In special circumstances. ( 21-Easements, Ri ht-cf•wa 9 y grants <br />Contract Date (MM/DD/YYYy) Sales Price <br />0 D $� <br />Describe arr unusual or s edal draimstances related to this sale indudin the s ecincatlon of an less-than-com lele ownershi interest and terms of seller financinn <br />A <br />