Sales Disclosure Form {46021}

SALES DISCLOSURE FORM State Form 46021 (R11/1211) Prescribed by Department of Local Government Finance Pursuant to IC 61.15.5 SDF ID County Year Unique ID SDF Date: __________________________ PRIVACY NOTICE: The telephone numbers and Social Security numbers of the parties on this form are confidential according to IC 61.15.53(d). PART 1 ­ To be completed by BUYER/GRANTEE and SELLER/GRANTOR A. PROPERTY TRANSFERRED ­ MUST BE CONVEYED ON A SINGLE CONVEYANCE DOCUMENT 1. Property Number A.) 7. Legal Description of Parcel A: B.) 7. Legal Description of Parcel B: Check box if applicable to parcel 5. Complete Address of Property 6. Complete Tax Billing Address (if different from property address) 2. Split 3. Land 4. Improvement 2. Split 3. Land 4. Improvement B. CONDITIONS ­ IDENTIFY ALL THAT APPLY If condition 1 applies, filer is subject to disclosure and a disclosure filing fee. YES NO CONDITION C. SALES DATA ­ DISCLOSE VALUE OF ITEMS LISTED IN TABLE B, ITEMS 115 1. Conveyance date (MM/DD/YYYY): _________________________________________________ 2. Total number of parcels: _______________________________________________________ 3. Describe any unusual or special circumstances related to this sale, including the specification of any lessthancomplete ownership interest and terms of seller financing. ______________________________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________ YES NO CONDITION 1. A transfer of real property interest for valuable consideration. 2. Buyer is an adjacent property owner. 3. Vacant land. 4. Exchange for other real property ("Trade"). 5. Seller paid points. (Provide the value Table C Item 12.) 6. Change planned in the primary use of the property? (Describe in special circumstances in Table C Item 3.) 7. Existence of family or business relationship between buyer and seller. (Complete Table C Item 4.) 8. Land contract. Contract term (YY): ________________________ and contract date (MM/DD/YYYY): ______________________________ 9. Personal property included in transfer. (Provide the value Table C Item 5.) 10. Physical changes to property between March 1 and date of sale. (Describe in special circumstances in Table C Item 3.) 11. Partial interest. (Describe in special circumstances in Table C Item 3.) 12. Easements or rightofway grants. 4. Family or business relationship existing between buyer and seller? Amount of discount: $________________________________________ Disclose actual value in money, property, a service, an agreement, or other consideration. If conditions 1315 apply, filers are subject to disclosure, but no disclosure filing fee. YES NO CONDITION 5. Estimated value of personal property: $ 6. Sales price: YES NO CONDITION $ 13. Document for compulsory transactions as a result of foreclosure or express threat of foreclosure, divorce, court order, judgment, condemnation, or probate. 14. Documents involving the partition of land between tenants in common, joint tenants, or tenants by the entirety. 15. Transfer to a charity, notforprofit organization, or government. 7. Is the seller financing sale? If yes, answer questions (813). 8. Is buyer/borrower personally liable for loan? 9. Is this a mortgage loan? $ % $ American LegalNet, Inc. www.FormsWorkFlow.com 10. Amount of loan: 11. Interest rate: 12. Amount in points: 13. Amortization period: INDIANA SALES DISCLOSURE FORM SDF ID: _________________________________ Page 2 D. PREPARER ______________________________________________________________________________________________ Preparer of the Sales Disclosure Form Address (Number and Street) ______________________________________________________________________________________________ Title ______________________________________________________________________________________________ ______________________________________________________________________________________________ City, State, and ZIP Code Company ______________________________________________________________________________________________ ______________________________________________________________________________________________ Telephone Number Email E. SELLER(S)/GRANTOR(S) ______________________________________________________________________________________________ Seller 1 Name as appears on conveyance document ______________________________________________________________________________________________ Seller 2 Name as appears on conveyance document ______________________________________________________________________________________________ Address (Number and Street) ______________________________________________________________________________________________ Address (Number and Street) ______________________________________________________________________________________________ City, State, and ZIP Code Telephone Number ______________________________________________________________________________________________ City, State, and ZIP Code Telephone Number ______________________________________________________________________________________________ Email ______________________________________________________________________________________________ Email 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 61.15.5, "Real Property Sales Disclosure Act". ______________________________________________________________________________________________ Signature of Seller ______________________________________________________________________________________________ Signature of Seller ______________________________________________________________________________________________ Printed Name of Seller Sign Date (MM/DD/YYYY) ______________________________________________________________________________________________ Printed Name of Seller Sign Date (MM/DD/YYYY) F. 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