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INDIANA SALES DISCLOSURE FORM Paget <br />- b ,rr•� -d .� N.It �.i ���, - -1 C�'4'"��� ,��� -J�r.- e - .� i� I' .,r:;� r <br />`Seller I - Name or Entity as appears on need <br />1 City of South Bend <br />Address <br />227 West Jefferson Blvd., Ste 1300„ <br />City. Town, or Post Office State ZfPCode <br />South Bend I �� �i�f Q�L --L U <br />Seller 2- Name or Entity as appears on deed <br />Address <br />City, Town, or Post Office Slate ZIP Code <br />I- - - I i -i - I -1-i-J-1-i - <br />Tittle Company Name (if applicable) Title Company Phone <br />__j <br />I - Name or Enhry as appears on deed <br />South Bend Heritage Foundation j Wiillthis property bethe <br />f buyers primary <br />Address residence? <br />803 Lincoln Way West 0Yes 0No <br />City. Town, or Post Office State ++ ZIP ICooe <br />1 l f f <br />South Bend --- - - -- 1 � I �! b-f �J LW �!-J-1 <br />Buyer 2 - Name or Entity as appears on deed <br />Address <br />City, Town, or Post Office Stale ZIP Code <br />JJ - JJ I <br />Under penalties of perjury, I hereby certify that this Sates Disclosure, to the bestof my knowledge and belief, is true, correct and camplele as required by law, and <br />Is prepared in accordance with IC 6,1j-5.5, "Real Property Sales Disclosure Act". <br />Signature of Seiler Signature of Buyer <br />SMBuyer Sign Date <br />9n <br />Q,`MD' (MMiDDrrNY) <br />Seller Phone Buyer Phone <br />�h/�j - —1 U <br />- tp� r la! r- a •- a r- <br />County Assessor orother assessing orricaf must verity and complete the following Information: <br />3Q �!i'' 7 O Significant physical changes to property between March 1 and data of sale <br />11 "DDi310R L � t{l� $ I AV LAND Property class. <br />V � I I I J-1-1 <br />v5a code <br />� �� f� ,7mting 01strict IOLGF assignedl <br />� CL y I I i AV Ih1PV I f tI/j f tI JJ JJ <br />Comp <br />� i�'/ ��,p'g �o�l!TT((�� 0 l <br />)f wa, Trrtr15( h�B k `� �� J i AV TOTAL O Valid Sale <br />��I_j_ ��_ NEIGHBORHOOD CODE <br />