Sales Disclosure Form - $250,000AUG ei6 '01 03:00PM WALLACK SOMERS HAAS
SALES DISCLOSURE FORM
State Form 46021 (R3 /1.00)
Approved by State Board of Accounts, 2000
Prescribed by the State Board of Tax Commissioners, 1999
Pursuant to IC 6- 1.15.5
P.2/32
Part 1 - -To he co;npleted hyrBUYER and
First name(*)
rr City of Carmel Redevelopment Commission
SELLER <1see instructions orrreverse s(de)
M.I.(s)
Last names)
u.I:
r; t. Address (number end street)
s
11.1
Printery residence?
❑Yes No
to Gity, Town or Post Office
State II I
ZIP code
First name(s)
E, Nicholas Kestner 1
M.I.(s)
Last name(s)
Address (number and street)
w`
Primary residence?
DYes an No
›. Cdy, Town or Post Office
State
ZIP code
- Send tax bills and notices to this address?
(Yes DNo
If no, provide mailing address (number and street city state, ZIP code)
Street address
<ci
. w City Center Drive i
�
CIli
Ctty, Town er Post Office
Carmel 1
State
IN i
ZIP code
46032
cc a County
. �
Hamilton 4
Township
Clay 1
Schad Corporation Name
Carmel Clay {
EXEMPT TRANSACTIONS (see Instructions on reverse side)
Exempt Transaction?
❑Yes WINO
If yes, specify the number of the exemption. (sae 'Exempt Tiansectlons" on reverse side)
SALES INFORMATION
DATE OF SALE"
1. Total sales price
$ 250,000.00
2. Seller paid points
$ ( )
Month
De
Year
1
0
0 1
1
3. Net sales price (Niel minus line 2)
$ 250,000.00
Check ALL of the following conditions that apply to this sale.
❑ Transfer of entire parcel O Purchase of adjoining fend ® Vacant land O Exchange for other real property (' Trade')
CI Seller provided financing 0 Mobile home 0 Condominium Ein splits)
12 Existence of family or business relationship between buyer and seller ❑ Personal property Included in transfer (Estimated value $ )
Describe any unusual or special circumstances related to this sale, Including the specification of any less- than - complete ownership Interest, and
the terms of any saner financing.
Sale of 1.210 Acres '
PART 2_,!To be completed by COO T;Y'AUD(TOR"(see instrtruions nn'rriVerso,side)'
County Auditor must verify and complete the fallowing Information:
O Buyer and Seller Information °Safes price ❑Parts; i Key number Part of 16'09 -36. 00.00 - 005.1700 1
OAddress of property transferred ❑Conditions of sale °School corporation number
❑ Oat of sale4ransfer OWarranty deed? OYES ONO
^'.PART 3 ?To be coii,pfeted by'.000NTYASSESSOR (s' ee instructions on reiicrso side), ~ 3 �+
Coty Assessor must verify and complete the following Information:
County
°Significant physical changes to property between March 1 and date of sale
❑Current property record card attached
(]Property class/use code
ASSESSED VALUE (AV) INFORMATION
AV LAND $
AV IMPROVEMENT(S) $
AV TOTAL $ '
.'. PART :4 - Signature andAVerifrcation Section (see rristructrons_ort reverse ^ink, )
The parties t0 a rear property conveyance are required to frig this form and attest in writing and under the penalties of perjury that the information contained
herein is true and correct. A person who knowingty and Intentlonaay falsifies or omits any Information required on this form commits a Class A Infraction.
Under penalties Of perjury, I hereby certify that this Sales Disclosure, to the bast of my knowledge and belief, le true, correct and complete as requited
by law, and Is prepared in accordance with IC 6 -1.1- 1 Property Sales Disclosure Act^
i
Signature of Seller or representative /` /
L ' . .Air r ,11'64,+-
Signature of Buyer or representative
XI,/
Telephone number
111- z.31 -ortEs
Telephone number
'51'-74',F-/%9
Date signed (month, day, year)
5 19 or
Date signed (month, day, year
6— ,4,, —er