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® Page 2 <br />IINDIANA SALES DISCLOSURE FORM <br />Seller t - Name or Entity as appears on deed <br />City of South Bend <br />Address <br />227 W. Jefferson Blvd. Ste 1300 <br />City, Town, or Post Office State Z,,IP Code <br />south Bend J'J ,4J�lIJQ 11 IJ—� <br />Seller 2 - Name or Entity as appears on deed <br />Address <br />City, Town, or Post Office <br />State <br />J <br />ZIP Code <br />�U-1 <br />Title Company Name rif appficabfe) <br />Title Company �Phone <br />I <br />. <br />Buyer 1 - Name or Emily as appears on deed _ <br />— <br />�— <br />WII this property be the <br />Habitat for Hunan i t y <br />buyers primary <br />residence? <br />Address <br />O Yes O No <br />402 E. South Street <br />State <br />ZIP Code <br />City, Town, or Post Office _ _ <br />FSouth <br />Bend <br />I f\ <br />6uwer 2 - Name or Entity as appears an deed <br />Address <br />City, Town, or Post Office State ZIP Code <br />Under penalties of perjury, I hereby certify that this Sales Disclosure, [o the best of my knowledge and belief, is true, correct and complete as required by law, and <br />is prepared in accordance with IC 6-1.15.5, "Real Property Sales Disclosure Act". <br />Signaturewf B er <br />Signature of Seller <br />r = <br />!� <br />SSi ate (MM/OD(Myer Sign Date <br />Seiler Jt I� I Mid <br />(MMlD [YYYY)1 G� M'1'Y) (J <br />Seller Phone Buyer Phone <br />m County Assessor or other assessing ofrcal must verity and complete the following Information: <br />Significant physical changes to property between March 1 and date of Sala <br />�� f Property class <br />` AV LAND J <br />F•:Ie�I'i�' .i':�.7-^'. t)7'�'yl,,� dry $ usa cotle <br />Tailing District (f7LG IF assigned) <br />AV IMPV <br />Completion � No <br />I AV TOTAL O Valid Salo <br />Date Entered in Transfer Book <br />_—�—I L! ICJ <br />—1I—J..J�� �J� —! NEIGHBORHOOD CODE <br />