State Form 46021 - Sales Disclosure Form - Indiana Page 3

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INDIANA SALES DISCLOSURE FORM

SDF ID:_________________________________

Page 3

PART 2 - COUNTY ASSESSOR

The county assessor must verify and complete items 1 through 14 and stamp the sales disclosure form before sending to the auditor:

1. Parcel

2. AV Land

3. AV Improvement

4. AV Personal

5. AV Total

6. Property

7. Neighborhood

8. Tax District

9. Acreage

Property

Class Code

Code

A.)

B.)

YES

CONDITION

10. Identify physical changes to property between March 1 and

Assessor Stamp

date of sale. _____________________________________________________________

11. Is form completed?

____________________________________________________________________________

12. Sales fee required?

____________________________________________________________________________

13. Date of sale

(MM/DD/YYYY)

________________________________________________

____________________________________________________________________________

14. Date form received

(MM/DD/YYYY)

________________________________________________

____________________________________________________________________________

Items 15 through 18 are to be completed by the assessor when validating this sale:

YES

CONDITION

15. If applicable, identify any additional special circumstances relating to validation of sale. _________________________________

16. Sale valid for trending?

__________________________________________________________________________________________________________________________________________

17. Validation of sale complete

__________________________________________________________________________________________________________________________________________

18. Validated by: ______________________________

__________________________________________________________________________________________________________________________________________

PART 3 - COUNTY AUDITOR

YES

CONDITION

1. Disclosure fee amount collected: $__________________________________

Auditor Stamp

6. Is form completed?

2. Other Local Fee: $____________________________________________________

7. Is fee collected?

3. Total Fee Collected: $_________________________________________________

8. Attachments complete?

4. Auditor receipt book number: ______________________________________

5. Date of transfer

: _______________________________________

(MM/DD/YYYY)

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _

PART 4 – RECEIPT FOR STATEMENT OF CREDIT/DEDUCTION OF ASSESSED VALUATION

______________________________________________________________________________________________

SDF ID

SDF Date

Buyer 1 - Name as appears on conveyance document

(MM/DD/YYYY)

______________________________________________________________________________________________

Parcel Number

Address of Property (Number and Street)

List the deductions for which the Sales Disclosure Form is application:

______________________________________________________________________________________________

City, State, and ZIP Code of Property

______________________________________________________________________________________________

Auditor Signature

Date

(MM/DD/YYYY)

A person who knowingly and intentionally falsifies value of transferred real property, or omits or falsifies any information required to be provided in

the sales disclosure form commits a Class C felony.