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.' �q'i.. STA T fi O <br />SALES DISCLOSURE FORM <br />�; _ t' ' ➢ State Form 46021 (RQ944) PRIVACY NOTICE; The telephone <br />N _ A' cnumbers of the onfidential according parties tan this o IC 8 form <br />are <br />_ Prescribed by Department of Local Government Fnance <br />Pursuant to IC 6.1.1-5.5 3(d). <br />Parcel NumberWert ci -o,$) (Show additional parcels on separate sheet if necessary.) Acreage or Lot Size (sl <br />JJJ o 9 J� 4 IJiJJ_1JIJ IJ_I I�JF _IJJJ-JJ1 ► c <br />JJ JJJJJJJJJJJJJJJJJ JJ JJJJJJ c <br />Address J JJ JJ Li JJJJJ IJJJ_JJ J 1J.JJJ 0 <br /># of Parcels <br />k 147 Burns JJJ <br />City, Town, or Post Office State ZIP Cade <br />South Bend I J JJJJ - JJ_JJ <br />Tax Billing Address (if other than orcoerty address) <br />1 803 Lincoln !day !lest <br />City, Town, or Post office State ZIP Code <br />F South Bend Zkil A 6161J6 JJJJ <br />Lot 85 Hartman's and Miller's Addition <br />Identify all conditions/items that apply NOTE: If items 12-21 apply, filers are not subject to disclosure <br />filing fee. <br />O1-Buyer is an adjacent property owner <br />n2-Vac3nt Land <br />O3-Exchange for other real property ("Trade") <br />O4-Seller Paid Points; amount if applicable <br />0 JJT <br />O5-Change planned in the primary use of the property? Describe in <br />special circumstances. <br />O6-Existence of family or business relationship between buyer and seller <br />O7- Land Contract Dated: <br />OB-Personal property included in transfer; amount if applicable <br />$J 1� � <br />O9- Significant physical changes to property between March 1 and date of sale <br />10- Non -Warranty deed; specify type 4U It C l a! m <br />O11- Partlal intere$t Describe In special circumstances. <br />Contract Date (MM/DD/YYW) Sales Price <br />Descnbe any unusual or special circumstances related to this sale, including the specification of any less -than -cal <br />I1 <br />O12-Security Interest documents such as mortgages or trust deeds. <br />O13-Leases less than 90 years <br />O14-Document resulting from foreclosure, or express <br />threat of foreclosure, divorce court order, condemnation, <br />probate or otherjudicial proceedings. <br />O15-Agreements and other documents for <br />mergers, consolidations, and incorporations <br />O16-Quitclaim deeds not serving as a source of title <br />O1?-Documents involving the partition of land between <br />tenants in common, joint tenants, or tenants by the <br />entirety. <br />(�( 19-Transfer to a charity, not -for -profit or government <br />tiJ Institution <br />O19-Transfer for no or discounted consideration, or gift <br />O20-Rerecording to correct prior recorded document <br />O21-Easements, Right-of-way grants <br />, <br />Clete ownership interest and terms of seller <br />61 <br />-A <br />