Sales Disclosure Form - $1,445,000RUG 06 '01 03:01PII WRLLRCK SOMERS HAPS
SALES DISCLOSURE FORM
State Form 45021 (R3/1 -00)
Approved by State Board of Accounts. 2000
Prescribed by the State Board of Tax Commissioners, 1999
Pursuant to IC 6- 1.1 -5.5
P.3/32
- ;- Part, 1 -To be conlpleteq•by:BUYER•an
First name(s)
E. Nicholas Keetrter
W
d SELLER (coe i
M.i,(s)
istructrons on reverse side) - ,•
Last name(s)
.J: Address (number and street)
Primary residence?
(jj City. Tawn or Past Office
•
State
ZIP sada
Fxst names)
CUy of Carmel Redevelopment Commission
l M_L(sy
L
Last name(s)
,CL Address (number alto shaeQ
Primary residence?
ClYes 3 .
_" City, Town or Post Office
State
ZIP code
F0
send tax bills and notices to this address?
11Yes 0 N
if no, provide mailing address (number end street, city, state, ZIP code)
Street address
South Rangeline
u Cry, Town or Pose t�tfiee
o n' Carmel I
Stale
IN
ZIP code
46032 i
a a r County
Harrulton I
Township
Clay '
School Corporetlon Name
Carmel Clay i
EXEMPT TRANSACTIONS (see lnstrucfons on reverse side)
Exempt Transaction?
QYes ($J No
iryes, spedfy the number of rho axomptlen. (see' ExemptTren ecjions'rur reuarse side)
SALES INFORMATION
DATE OF SALE
1. Total sales prier:
$1.450.00°.0°
2. Seller paid points
$
Month
Da
Year
0
s
1 4
2 I°
I°
r 1
I
I 1 I
3. Net sales price (line 1 m►nus Nne 2j
$ 1,aso,000.00
Check ALL of the following conditions that apply to this eale.
❑Transferor entire parcel Q Purchase of adjdntng land Q Vacant land Q Exchange for other tea] property (Trede�
o Seller provided financing Q Mobile home O Condominium ®Spiit(s)
❑ Existence of (amity or business relationship between buyer and seller Q Personal property included in transfer (ESf1rn led value $ 1
Describe any unusual or special circumstances related to thls safe, Including the specification of any less-than•complat ownership Interest, and
the terrns of any seller financing.
. - 'PART To ire compietedaby COUNTY AUDITOR (see instraCtions on reverse`stde) - 1''r. _ rI-
County Auditor must verify and complete the following information:
O Buyer and Seller information ['Sales price QParcel / Key number 16-09.36- 00-00- 009.000
Q Address of property transferred ['Conditions of sale ❑Sdtool corporation number
Q Date of sale/transfer [Warranty deed? OYES ONO
,, .. . PART :3 :.To be`ioinpleted.by.COUNTY
ASSESSOR (see insi uetrons'en' reverie side)
County Assessor must verify and complete the following Information:
QSigniificaet physical changes to property between March 1 and date of sale
OCunent property record card attached
[]Property Class fuse code
ASSESSED VALUE (AV) INFORMATION
AV LAND S
AV •
AV TOTAL S
., -'f, '.;+' ..x „ ',, PART. 4=- 'Signature and` Verification .Seclronlsee- lnstruCtio/is on,reversC' i' - n'
The parties to a real property conveyance are required to foe this form and attest in wrfdng and under the penalties of perjury that the information contained
herein is true and correct. A person who knowingly and intentionally falsifies or omits any Informetion required on this form commits a Class A infraction.
Linder penalties of perjury, I hereby certify that this Sates Disclosure, to the beat of my knowledge and belief, Is true, correct and complete as required
by taw, and la prepared In accordance with IC 6- 1.1.5.5, "Real Property Sales Disclosure Act."
Signatures of Seller or representative
y'� i !/
r/�.�=
Telephone number
d �v s !� S' G
Date signed (month, day, veer)
/•+ n 1
Signature of!)
1�`AIIIIWrr;r.r. - - .
_
Telephone number
3ii-Z31 -ozz8
Dale . lgn (month. day, year)
5- /It OI