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Date: <br />Angela Jacob <br />Clerk of the Board of Public Works <br />City of South Bend <br />225 West Jefferson Blvd <br />County -City Building, Room 1316 <br />South Bend, IN 46601 <br />Dear Ms. Jacob: <br />is y���t• �. <br />REQUEST TO PURCHASE, OR TO REQUEST PERMISSION <br />FOR THE TEMPORARY USE OF CITY -OWNED PROPERTY <br />I am interested in (circle one): ) urchasing OR 2) applying for temporary use of, a vacant lot or lots owned by the <br />City of South Bend. The lot(s) is/are as follows: <br />Key Number: Address: <br />Parcel 1 17 `30 (,,, Z - Z3 9 :� ZiJ I �. c-� <br />Parcel 2 <br />I own property next to this/these lot(s) \/ <br />I do not own property next to this/these iot(s) <br />1 V ■ �. i Iit' <br />The reason for my interest in this/these lot(s) is to (please print): <br />I understand that there is a public bidding procedure that the City of South Bend has to follow for the sale of City - <br />owned property, and I further understand that in addition to the purchase cost, there is the cost of advertising the in <br />the newspapers, both of which I am responsible for if I am the successful bidder. I am posting the required $100 <br />deposit fee with this request. If I am the successful bidder, the $100 deposit will be applied towards the total sale <br />price. If I do not submit a bid on the lot or lots, and if no other bids are submitted, I will forfeit the $100 deposit, <br />which will be applied to advertising and staff costs. There is no deposit required for a request for the tempotary use <br />of City -owned property. <br />I further represent that I do not currently owe any delinquent taxes, assessments, penalties, interests or costs <br />attributed to a tax sale of real property, either in St. Joseph County or in any other County in the State of Indiana. <br />You may reach me at(Please print): <br />Street Address I ZL) C 5 City & Zip:_ Sou{ hod , IN '4&e f q <br />Phone Numbet5 I q } 2 D �— J-I q C . <br />Sincerely, <br />F.•IDATALSHARFIDPNDVLatrd ManagenrerrtlCity Property FilesUA Purchase Request Form.doc <br />