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1 <br />i <br />SALES DISCLOSURE FORM <br />Slate Form 48021 (R4/9-04) PRIVACY NOTICE: The telephone <br />numbers of the parties nthis form re <br />Prescribed by Department of Loral Government Financence <br />confidential according to IC 6 1.1 5 5 Ilf(�fl(IIII(III1(Il�(I��(INf [IIII(llf ill( I <br />Pursuant to IC 8.1 1.5.5 <br />3(d), <br />Parcel Number(s) (Show additional parcels on separate sheet if necessary.) Acreage or Lot Size Pan of Parrs <br />lard <br />J�J 1 0 2 1 JJ� 5 I iJJJ J 1 1 i JJJ_I JJJ J jb�]� o <br />JJJJJJJJJJJJJJJJJJJJ JJJ J.JJ o <br />_iJJJJJJ I I_UJJ�JJ�JJ�J_iJ �_,_I_' JJ ' '=- <br />Address <br />9 of Parcels <br />103 Carlisle <br />�I i <br />City, Town, or Post Office <br />Stale <br />ZIP Code <br />JA <br />j4ddA 81 <br />- JAJJ <br />South Bend <br />Tax Billing Address (if other than property address) <br />402 E. South Street <br />City, Town, or Post Office Stale ZIP Code <br />I� South Bend --- T INt JJ16IO]lj J�JJ <br />Lot 124 Oak Grove tat Addition <br />Identify all conditions/items that apply <br />0 1-Buyer is an adjacent property owner <br />0 2-Vacant Land <br />0 3-Exchange for other real property ('Trade") <br />o. 4-Seller Paid Paints; amount if applicable <br />$ I � . F_ -I _J� , <br />0 5-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 />filinq fee. <br />0 6-Existence of family or business relationship between buyer and seller <br />0 7- Land Contract Dated; <br />oB-Personal property included in transfer, amount if applicable <br />0 9- Significant physical changes to property between March 1 and date of sale <br />© 10- Non -Warranty deed; specify type Q u I t C l a i m <br />0 11- Partial Interest Describe in special circumstances. <br />0 12-Security interest documents such as mortgages or trust deeds. <br />0 13-Leases less than 90 years <br />0 14-Document resulting from foreclosure, or expre4. <br />ss <br />threat of foreclosure, divorce court order, condemnation, <br />probate or other judicial proceedings. <br />0 15-Agreements and other documents for <br />mergers, consolidations, and Incorporations <br />0 16-Quitclaim deeds not serving as a source of title <br />0 17-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 />0 19-Transfer for no or discounted consideration, or gift <br />0 20-Rerecording to correct prior recorded document <br />0 21-Easements, Right-of-way grants <br />Contract Cate (MM/DCffyyy) <br />Sales Price <br />- FT I <br />Describe any unusuaf or special circumstances related to this sale, including the specification of any less -than -complete ownership interest and terms of seller financing. <br />Nq <br />.4 <br />