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Closing Documents Thomas Jones - Shelborne Road ProjectCLOSING STATEMENT Section 6045 of the Internal Revenue Code, as amended by the Tax Reform Act of 1986, requires the reporting of certain information on every real estate transaction. The information provided below, except for the tax identification number, is adequate information to provide to a tax professional. FEE OWNER: Thomas R. Jones ADDRESS: 12210 Shelbome Road, Carmel, IN 46032 DESCRIPTION OF PROPERTY: A part of the NE of Section 31, Township 18 North, Range 3 East, Hamilton County, Indiana PROJECT: 06-21 (Shelborne Rd — 116th to 131st) PARCEL: 9 CLOSING DATE: LAND AND/OR IMPROVEMENTS: $20,970.00 DAMAGES: COUNTY: PURCHASE PRICE: ADMINISTRATIVE SETTLEMENT: Hamilton $ 30,000 00 $ 2,765.00 $ 6,265.00 I (we) certify that the above is true and correct and acknowledge receipt of payment. Please be advised that no property taxes have been assumed by the City of Carmel in connection with the purchase of the above -captioned property. Any applicable tax adjustment, due to the above purchase by the City of Carmel, would be accomplished by the County Assessor after the deed is recorded by the City or its agent. This is supposed to be done; however, you should take the initiative to make this adjustment. The City of Carmel has no authority to remove or change any taxes of any nature. Fee Owners Signatu e Date Signature Date 3417 Sherman Orive • Beech Grove, Indiana 46107 ■ Tel 317.760.1555 • Fax 317•780•6525