Enviromental Disclosure For Transfer Of Real Property (IC 13-25-3-7.5) {52653}

ENVIRONMENTAL DISCLOSURE FOR TRANSFER OF REAL PROPERTY (IC 13-25-3-7.5) State Form 52653 (R5 / 6-12) INDIANA DEPARTMENT OF ENVIRONMENTAL MANAGEMENT INDIANA DEPARTMENT OF ENVIRONMENTAL MANAGEMENT 100 N. Senate Ave., MC66-30 IGCN 1101 Indianapolis, IN 46204 Telephone: (317) 234-0338 A WARNING TO THE PARTIES TO A TRANSFER OF PROPERTY: The single act of reading this document does not constitute "all appropriate inquiries" into the previous ownership and uses of the facility to satisfy that requirement under the federal Comprehensive Environmental Response, Compensation and Liability Act (42 U.S.C. 9601(35)(B)). You are strongly encouraged to read this document carefully and to take all other actions necessary to make a due diligence inquiry into the previous ownership and uses of the facility if you intend to satisfy the criteria to avoid liability under the federal Comprehensive Environmental Response, Compensation and Liability Act or IC 13-25-4. LIABILITY DISCLOSURE Transferors and Transferees of real property are advised that their ownership or other control of such property may render them liable for environmental cleanup costs whether or not they caused or contributed to the presence of environmental problems in association with the property. PART ONE: PROPERTY IDENTIFICATION A. Address of Property: City or Town Township Parcel Identification Number(s). (18-digit format in compliance with 50 IAC 26-8-1): B. Legal Description: Section Township Range Enter or attach complete legal description in this area: C. Property Characteristics: Lot Size Acreage Check all types of improvement and uses that pertain to the property: Apartment Building (6 units or less) Commercial Apartment (over 6 units) Store, Office, Commercial Building Industrial Building Farm, with Buildings Other (specify) American LegalNet, Inc. www.FormsWorkFlow.com PART TWO: NATURE OF TRANSFER A. (1) Is this a transfer by deed or other instrument of conveyance of fee title to property? (2) Is this a transfer by assignment of over 25% of beneficial interest of a land trust? (3) A lease exceeding a term of 40 years? (4) A collateral assignment of beneficial interest? (5) An installment contract for the sale of property? (6) A mortgage of trust deed? (7) A lease of any duration that includes an option to purchase? B. (1) Identify Transferor: Name of Transferor Current Address of Transferor State: Trust No. Name and Address of Trustee if this is a transfer of beneficial interest of a land trust. _ Yes Yes Yes Yes Yes Yes Yes No No No No No No No City ZIP (2) Identify person who has completed this form on behalf of the Transferor and who has knowledge of the information contained in this form. Include name, position (if any), address and telephone number. Name Address Telephone ( ) Position City State: ZIP C. Identify Transferee: Name of Transferee Current Address of Transferee State: ZIP City American LegalNet, Inc. www.FormsWorkFlow.com PART THREE: ENVIRONMENTAL INFORMATION A. Regulatory Information During Current Ownership 1. Has the Transferor ever conducted operations on the property which involved the generation, manufacture, processing, transportation, treatment, storage, or handling of a "hazardous substance" (as defined by IC13-11-298)? This question does not apply to consumer goods stored or handled by a retailer in the same form and approximate amount, concentration, and manner as they are sold to consumers, unless the retailer has engaged in any commercial mixing (other than paint mixing or tinting of consumer sized containers), finishing, refinishing, servicing or cleaning operations on the property. Yes No 2. Has the Transferor ever conducted operations on the property which involved the processing, storage, or handling of petroleum, other than that which was associated directly with the Transferor's vehicle usage? Yes No 3. Has the Transferor ever conducted operations on the property which involved the generation, transportation, storage, treatment, or disposal of "hazardous waste" (as defined in IC 13-11-2-99(a))? Yes No 4. Are there any of the following units (operating or closed) at the property that are used or were used by the Transferor to manage hazardous wastes, hazardous substances, or petroleum? Landfill Surface Impoundment Land Application Waste Pile Incinerator Storage Tank (above ground) Storage Tank (underground) Container Storage Area Yes Yes Yes Yes Yes Yes Yes Yes No No No No No No No No Injection Wells Wastewater Treatment Units Septic Tanks Transfer Stations Waste Recycling Operations Waste Treatment Detoxification Other Land Disposal Area Yes Yes Yes Yes Yes Yes Yes No No No No No No No If there are "YES" answers to any of the items in Part Three A., and the transfer of property that requires this document to be filed is other than 1) a mortgage or trust deed, or 2) a collateral assignment of beneficial interest in a land trust; you must attach a site plan that identifies the location of each unit to the copies of this document that you file with the county recorder and the Department of Environmental Management. 5. Has the Transferor ever held any of the following in regard to this real property? (A) Permits for discharges of wastewater to waters of Indiana. (B) Permits for emissions to the atmosphere. (C) Permits for any waste storage, waste treatment, or waste disposal operation. 6. Has the Transferor ever discharged any wastewater (other than sewage) to a publicly owned treatment works? Yes Yes Yes Yes No No No No American LegalNet, Inc. www.FormsWorkFlow.com PART THREE: ENVIRONMENTAL INFORMATION (continued) 7. Has the Transferor been required to take any of the following actions relative to this property? (A) Filed an emergency and hazardous chemical inventory from pursuant to the federal Emergency Planning and Community Right-to-Know Act of 1986 (42 U.S.C. §11022). (B) Filed a toxic chemical release form pursuant to the federal Emergency Planning and Community Right-to-Know Act of 1986 (42 U.S.C.§11023). Yes No Yes No 8. Has the Transferor or any facility on the property or the property been the subject of any of the following state or federal governmental actions? (A) Written notification regarding known, suspected, or alleged contamination on or emanating from the property. (B) Filing an environmental enforcement case with a court or the solid waste management board for which a final order or consent decree was entered. (C) If the answer to question (B) was Yes, indicate whet