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Sales Disclosure Form SALES DISCLOSURE FORM •-- State Form 46021(R419-04) PRIVACY NOTICE: The telephone III 1111 IIIIII II I II III .1,1; numbers of the parties on this form are Prescribed by Department of Local Government Finance confidential according to IC 6-1.1-5.5- \' :.:..`.; Pursuant to IC 6-1.1-5.5 3(d). 1616 ;; F�.yL r t 2+^. t!K. a'' roz,t,.rr- L#+, !c'• rs i:s`y+ ,r t 4 ;, ,g, -3:. F x xn -,i PART 1Tobe completed by,:,BUYER/GRANTEEi„and SELLER/GRANT,OR,(typed'or pnnted4in black ink). ,, Part of Pr Parcel Number(s) (Show additional parcels on separate sheet if necessary.) I 0 2 Jjjj 0 I AcrJJJJ eage or Lot Size 0 I g 1 1 6 Ii1_1 0 I - 3 L^l�ll!—!1J_JJ 0 'J-1 6 H Lii iii C j C W- Address #of Parcels �i. z 21 E. Main Street � j 1 City,Town,or Post Office State ZIP Code I ---III Carmel I JJ � 6 I 1 1 2 _Lt.]--��--JJ J has: Tax Billing Address(if other than property address) One Civic Square City,Town,or Post Office State ZIP Code Carmel JJJI JJJJJ Legal Description Part of Lot 5 and Part of Lot 6, Carmel Original Identify all conditions/items that apply NOTE: If items 12-21 apply,filers are not subject to disclosure fY filing fee. O 1-Buyer is an adjacent property owner O 12-Security Interest documents such as mortgages or trust deeds. O2-Vacant Land O 13-Leases less than 90 years O3-Exchange for other real property("Trade") O 14-Document resulting from foreclosure,or express • O 4-Seller Paid Points;amount if applicable threat of foreclosure,divorce court order,condemnation, probate or other Judicial proceedings. Or O 5-Change planned in the primary use of the property?Describe In 15-Agreements and other documents for 1_'? mergers,consolidations,and Incorporations p special circumstances. O' 0 6-Existence of family or business relationship between buyer and seller O 16-Quitclaim deeds not serving as a source of title O 7-Land Contract Dated: O 17-Documents involving the partition of land between tenants in common,Joint tenants,or tenants by the O8-Personal property Included in transfer;amount if applicable entirety. O18-Transfer to a charity,not-for-profit or government Institution • O 9-Significant physical changes to property between March 1 and date of sale O 19-Transfer for no or discounted consideration,or gift µ} c O 10-Non-Warranty deed;specify type O 20-Rerecording to correct prior recorded document O11-Partial interest. Describe In special circumstances. O 21-Easements,Right-of-way grants - Contract Date(MM!DDNYYY) Sales Price < 1 1 / 0 3 / 2 0 0 4 $ , 2 ,20 4 o Describe any unusual or special circumstances related to this sale,including the specification of any less-than-complete ownership interest and terms of seller financing. te': Purchaser is the City of Carmel Redevelopment Commission ® INDIANA SALES DISCLOSURE FORM Page 2 N ., ,:..`TP t r » rF.. , tr�g, u +. k,uw ,.:..� .yam 16 2,, +,. e �,� i 4 ,�5. PART 1 To be completedby BUYER/GRANTEE and SELLERIGRANTOR,(typedorpnnted in,biack ink)�.� Seller 1-Name or Entity as appears on deed 'k Marshall E. and Sandra Lee Andich, husband and wife • Address • 1.,V-t` P O Box 494 ita ice- City,Town,or Post Office State ZIP Code JJ jJJj2 JllJ Carmel I N 4 Ff.-.0' Seller 2-Name or Entity as appears on deed ;, Address f;. City,Town,or Post Office State I ZIP j Codel . .k` __Li J_jJJ Th Title Company Name(if applicable) Titlej Company lPhone rrl JJ _____JJ J __-i :Ti.;..;, i ``,. Buyer 1-Name or Entity as appears on deed City of Carmel Redevelopment Commission Will this property be the buyer's primary Address residence? ` One Civic Square O Yes No ,1vt ) City,Town,or Post Office State ZIP Code c. Carmel Jj ± ����J - _Li] Buyer 2-Name or Entity as appears on deed 0, Address }.. City,Town,or Post Office State _1_1_1_1_1,,-,_,‘., e I ZIP Code 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". Signature of Seller Signature of Buyer t, 1' raillirAMIPMMIIIIII. n ,'=` eller Sig Date B er Sig r.to 'i0, (MM/DD/YYYY) 1 1 / 0 3 / 2 0 0 4 M/DD Y) 1 1 / 0 3 / 2 0 0 4 Seller Phone Buyer Phone 1/ H - I 7I,i7l - U I/ I/I'71 A b Jli - 7%.1 .1.1_1 - _f_Ifle ,,, .. i PART12 COUNTY AUDITQR, , ` Y.. . y..,r, ,_::, PART 3, COGNT,Y;OR TOWNSHIP ASSESSOR , - . 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 AUDITOR'S FILE STAMP $ AV LAND I� I Property class/ JJ use code Taxing District(DLGF assigned) $ AV IMPV J_JJ_JJ t , Completion O Yes O No Date Entered in Transfer Book $ AV TOTAL O Valid Sale / I 111 I 1 1 1 1 I 1 11 NEIGHBORHOOD CODE Its 6 INDIANA SALES DISCLOSURE FORM Page 3 • .. � ... '� 4 �i., w n:t .. rr.7 e. 4 lak J s J ...! r . •.• " .. ./!:j; INSTRUCTIONS Indiana law requires a sales disclosure form to be completed when a conveyance document(see definition below)is filed with the county auditor. The county auditor may not accept a conveyance if(1)the sales disclosure form is not included with the conveyance document;or (2)the sales disclosure form is incomplete. A person filing a sales disclosure form shall pay a fee of ten dollars($10.00)to the county auditor. PART 1: BUYER AND SELLER INFORMATION Property Transferred Information. Either the buyer/grantee or the seller/grantor should provide the parcel number(s)(including all dashes and decimals), full address,tax billing address, lot size, and legal description of the parcel(s)transferred. A legal description is especially important for metes and bounds descriptions and new parcels. If the transaction consists of more than three parcels, an additional list of parcel numbers and lot sizes must be attached to this document. Sales conditionslitems. The information in this section is used to determine sales characteristics, establish market value,determine applicability of the sale and for use in ratio or other studies. The appropriate circle or circles should be filled in for all conditions/items that apply to the sale. With regard to personal property(see definitions below), the buyer or seller must enter an estimated value of the personal property included in the sale. Similarly,the buyer and seller must enter the amount of seller paid points as applicable. Please note that while indicating that certain conditions/items will result in not paying a filing fee, the buyer/grantee or seller/grantor is still responsible for completing the form in full. Sales Data. The date and sales price of the property transfer is to be printed in the spaces provided. Any unusual or special conditions of the sale that may affect the sales price or terms of the sales agreement should also be described. Seller/Grantor Information. Seller(s)/grantor(s)are to provide the full name and address for seller(s)or entity as applicable. If there are more than two individuals or entities involved in the transaction, additional ownership information must be included in an attachment to this form. The seller/grantor must also provide, if applicable, the name and telephone number of the title company that handled the transaction. Buyer/Grantee Information. Buyer(s)/grantee(s)are to provide the full name and address for buyer(s)or entity as applicable. If there are more than two individuals or entities involved in the transaction,additional ownership information must be included in an attachment to this form. The buyer/grantee must also indicate whether the property will be used as a residential primary residence. Signature and Verification. The buyer/grantee, seller/grantor or their representatives must sign one (1)sales disclosure form, or if the parties do not agree on the information to be included on the completed form, each party must sign and file a separate form. If anyone other than the buyer/seller or an attorney of the buyer/seller is filling out the form, a properly executed Power of Attorney must be completed and attached. A person who knowingly and intentionally falsifies or omits any information required on this form commits a Class A infraction. PART 2: COUNTY AUDITOR RESPONSIBILITY The county auditor is responsible for collecting the filing fee as well as ensuring that all parties to the conveyance have completed and signed the form as required. The county auditor may not accept the sales disclosure statement if the statement is not signed by the buyer or seller. If the buyer or seller fails to completely fill out their designated portion of the form,the county auditor may not accept the conveyance document. The county auditor must also confirm the date the property was duly entered for transfer. PART 3: COUNTY ASSESSOR INFORMATION The county assessor is responsible for determining whether or not significant physical changes have been made to the property between March 1 and the date of sale. The county assessor is also responsible for entering property class or use codes,the proper department of local government finance taxing district number, the current assessed value, and neighborhood code information. The county assessor and/or other assessing officials are responsible for verifying the sale as well (note that verification is not required prior to submitting sales data to the DLGF). Sales disclosure forms provided in response to public records requests should not include phone numbers. Definitions Conveyance Document means any document, land sale contract, deed, quitclaim deed serving as a source of title, or other document presented for recording, that purports to transfer a real property interest for valuable consideration. Personal property— items that are not attached (built-in or affixed)to the real estate(land and buildings). This might include items such as washers, dryers,window treatments,stoves and refrigerators. Other items considered personal property are boats and other vehicles, inventories(livestock, goods in process or for trade,or agricultural commodities)and machinery used in farming or manufacturing.