HomeMy WebLinkAboutSales Disclosure Form - 8-22-061
SALES DISCLOSURE FORM
State Form 46021 (R6R -06)
Prescribed by Department of Local Government Finance
Pursuant to IC 6- 1.1 -55
PRIVACY NOTICE: The telephone
numbers of the parties on this form are
confidential according to IC 6-1.1-5.5 -
3(d).
1111111111111111111111111111111111
To be completed by BUYER/GRANTEE and SELLER/GRANTOR (typed or printed in blade ink)
Parcel Number(s) (Show additional parcels on separate sheet if necessary.) Pan of Parcel
1 IHJJ ° IJ.--1Z-11--1(±111_1 IJ o I — Ip_lJJj d ! i d / I_i_I I Ae J JtJ J71_I 0 f
J I-JJJJ.JJ— I° IJiip_12_1— IJJ r I o IL1J 11._1 JJ.L IJ 0
A! IJ-I' k H I J_I ° 13 l — I_13 " IJ° 1 z I° JJJJ__I 1J__IJ JJ_ o
\ l� /\CtiY' 7 I2 ifl �� #ot Parcels
y �de 1 __Hy;
State ZIP Code
Ilzl2-0 hi- oo7cs4 e_
City, Town or Post Office
1 Ch/
Tax Billing Address
other than property address)
1 1 / 1 hf es � 1h n,N S / /10
Ciry, Town, or Post Office
€i
State ZIP Code
Sig - 1 1 1J
P/4-` dec 32 r !g eV— ? "/Lc
Legal Description
1
Identify all conditions /items that apply
O 1 -Buyer is an adjacent property owner
O 2- Vacant Land
O 3- Exchange for other real property ( "Trade ")
O d- Seller Paid Points; amount if applicable
•
NOTE: If items 12 -21 apply, filers are not subject to disclosure
T fee.
O 5- Change planned n the primary use of the property? Describe in
special circumstances.
O 6- Existence of family or business relationship between buyer and seller
0 7- Land Contract Dated:
O 8- Personal property included in transfe ; amount if applicable
I 1 1 1
0 9- S gnifcant physical changes to property between March 1 and date of sale
O 10- Non Warranty deed; specify type
O 11- Partial Interest. Describe in special circumstances.
Con ract Date MM/DD/YYYY)
/12.12-1/12-1°1° 161
Describe any unusual or pedal circumstances elated to thi
1°1 el
Sales Price
Illz
O 12Securlty Interest documents such as mortgages or trust deeds.
O 13- Leases less than 90 years
O 14- Document resulting from foreclosure, or express
threat of foreclosure, divorce court order, condemnation,
probate or other judicial proceedings. -
O 15- Agreements and other documents for
mergers, consolidations, and incorporations
O 16- Quitclaim deeds not serving as a source of title
O 17- Documents Involving the partition of land between
tenants in common, joint tenants, or tenants by the
entirety.
16- Transfer to a charity, not -for- profit or government
institution
O 19- Transfer for no or discounted consideration, or gift
O 20- Rerecording to correct prior recorded document
O 21- Easements, Right -of -way grants
1
ale, including the specification of any less- than - complete ownership interest and terms of seller financing.
010 °1
I
SALES DISCLOSURE FORM
State Form 46021 (R6/7 -06)
Prescribed by Department of Local Government Finance
Pursuant to IC 6- 1.1 -5.5
PRIVACY NOTICE: The telephone
numbers of the parties on this form are
confidential according to IC 6-1.1-5.5 -
3(d).
111 111!! 11111111111111111 111
r' PART,1`srTo be completed;by, BUYEWGRANTEE and,SELLER/G , r : i - ... z1,
RANTOR (tjiped or,printed In black ink)
1111111
Parcel e sheet if necessary.) Pan of Parcel
JJJJJJJJJJ%JJJJ.l 0111'
�� �0 p l z a J�J
_'JJJJJJJJ-J_l3JJJJJJJ�fJJJJJJJ JJJJ 0
A!JJJJJ J 3 JJ ° 13JJ °JJJJJ? JJ_JJ_°JJJJ JJJJ 1 0
izi-Lo JJJ
5 of Parcels
City, Town, or Post Office State ZIP Code j
��9JA J - JJJJ
Tax Billing Address (if other than property address)
1/ / 11jo s,/ /'b Aid S : , 5Le / /
City, Town, or Post Office
/
Legal Description
State
-4/1/
ZIP
t'J31J �JJJ
& cc.. o(°i 32 / �' — Lc
Identify all conditions /items that apply
0 1 -Buyer is an adjacent property owner
O 2- Vacant Land
O 3- Exchange for other real property ("Trade ")
O 4- Seller Paid Points; amount if applicable
Ill
0 5- Change planned in the primary use of the property? Describe in
NOTE: If items 12 -21 apply, filers are not subject to disclosure
filing fee.
special circumstances.
O 6- Existence of family or business relationship between buyer and seller
O 7- Land Contract Dated:
O 8- Personal property included in transfer; amount if applicable
1 1
O 9- S gnificant physical changes to property between March 1 and date of sale
O 10- Non - Warranty deed; specify type
O11- Partial interest. Describe in special circumstances.
Con ract Date (Mt•.1 /DD/YYYY)
oIg
2
z
L
0 12- Security Interest documents such as mortgages or trust deeds.
O 13- Leases less than 90 years
O 14- Document resulting from foreclosure, or express
threat of foreclosure, divorce court order, condemnation,
probate or other judicial proceedings.
O 15- Agreements and other documents for
mergers, consolidations, and incorporations
O 16- Quitclaim deeds not serving as a source of title
O 17- Documents involving the partition of land between
tenants in common, joint tenants, or tenants by the
entirety.
18- Transfer to a charity, not- for - profit or government
institution
0 19- Transfer for no or discounted consideration, or gift
O 20- Rerecording to correct prior recorded document
O 21- Easements, Right -of -way grants
Sales Price
i i2
Describe arty unusual or special circumstances elated to this sale, including the specification of any less- than-complete ownerstlip interest and terms of seller financing.
d
r
INDIANA SALES DISCLOSURE FORM
Page 2
ET W; =1d bo'dott pfetetl bq.111UVE14/60Ahlt- iiiii Sf =i_(: ktiGl7AfJT(712�(tYped �l`Ypii ite� in Mack inky._,; r� w..' x ">
Seller 1 - Name or Entity as appears on deed
ho0k5/•trL e r5'� � B� jaq e �L e__
Address 1 �1
ad 1 / , A 1, 37
ZIP Code
(21,
City, Town, or Post Office
Seller 2 - ame or Entity as appears on deed
State
Address
City, Town, or Post Office
Preparer Name and Address
SJ J ZJCJ � J J
Preparer PhoneIe _La]
Th - Th
Buyer 1 - Name or Entity as appears on deed
Address
O /ir//4 / S5f b N
!� / W e 394. i r k ( ) e f - ' 94 / �o
State ZIP Code
City, Town, or Post Office
aco, hi el
Buyer 2 - Name or Entity as appears on deed
Will this property be the
buyers primary
residence?
OYes
Address
City, Town, or Post Office
State ZIP Code
ThTh
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
is prepared in accordance with IC 6- 1.1 -5.5, "Real Property Sales Disclosure Act ".
SignatuLQof Seller -Signa Bu
Sc /k 's > rn~
Seller Sign Date /
(MNVDD /YYYY) / 2 / Z 7
Seller Phone
2
0
0
(e
%JJ JJ "1 JJJJ
':i n, 1'Af2t2 '.COUNIYAIJtjItOF!
uyer Sign Dale
(MM /DD /YYYY)
Buyer Phone
91t -71-
- A-A ?2]
4
Ir yg.. .}.a rt i rx;Sa'• e ,�" 4 Mkt 3. , liVU1V.1:,T,0R 10.1vNsNIp;At5ES5oa'>.
Completion O Yes
Date Entered in Transfer Book
County Assessor or other assessing offical must verify and complete the following information:
OSignificant physical changes to property between March 1 and date of sale
fI Property class I
JI JI use code
Taxing District (DLGF assigned)
AV LAND
AV IMPV
AV TOTAL O Valid Sale
I l l l l l l 1 I I I NEIGHBORHOOD CODE