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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