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r INDIANA SALES DISCLOSURE FORM <br />Page 2 <br />\ <br />Seller t - Name or Entity as appears on deed <br />Civil City of South Bend <br />Address _.. <br />227 1J. Jefferson Blvd. sto 1300 <br />City. Town, or Post Office Sttat�e ,,� <br />South Bend -�� <br />Seller 2 - Name or Entity as appears on deed <br />Address <br />City, Town, or Post Office Slate ZIP Code <br />�� JJJJ - JJJ <br />Preparer Name and Address Preparer Phone <br />JJJ-JJJ-JJJJ <br />1 - Name or Entity as aooears on deed <br />Northeast Nei ghborhood <br />Rev i tal i zat i on <br />Organ 1 zat i on <br />Will this property be the <br />buyer'spnmary <br />Address <br />residence? <br />0Yes 0Nc <br />303 Lincolriway West <br />City, Town, or Post Office <br />State <br />ZIP Code <br />JI <br />JJJJJ - <br />jj U <br />South Bend <br />NJ <br />Buyer 2 - Name or Entity as aooears on deed <br />Address <br />City, Town, or Post Office Slate ZIP Code <br />JJ JJJJJ-���� <br />Under penalties of perjury. I hereby certify that this Sales Disclosure, to the best of my knowledge and belief, is true, correct and complete as required by law, and <br />is prepared In accordance with fC 6-1.1-5.5, <br />"Real Property Sales Disclosure Act". <br />Signature of Seller <br />Signature of Buyer <br />Seller Sin Dat' <br />fIY`rWAMIQQ <br />f <br />! � <br />I I � o U <br />( M/YMyer Sign Oec' <br />MlDDYW <br />m I m! <br />Seller Phone <br />JJ� - <br />J�� <br />JJJ <br />Buyer Phone <br />JJJ <br />JJ JJJ <br />County Assessor or other assessing ofiicai must verify and complete the foilowmg information: <br />OSignificant physical changes to property between March 1 and date of sale <br />L�L�LJ AV tJANO —JJJ us...d class <br />use coda <br />Taxing 011slrict IOLGF aeslgnod <br />�O m0 f �AVIMPV <br />Completion O Yes ONO J <br />AV TOTAL O Valid Sale <br />Date Entered in Transfer Book <br />m I m I J NEIGHBORHOOD CODE <br />