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SALES DISCLOSURE FORM
State Form 46021 (R11/12‐11)
SDF ID
County
Year
Unique ID
Prescribed by Department of Local Government Finance
Pursuant to IC 6‐1.1‐5.5
__________________________
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
Check box if applicable to
5. Complete Address of Property
6. Complete Tax Billing Address (if different from
parcel
property address)
A.)
2. Split
3. Land
4. Improvement
7. Legal Description of Parcel A:
B.)
2. Split
3. Land
4. Improvement
7. Legal Description of Parcel B:
B. CONDITIONS – IDENTIFY ALL THAT APPLY
C. SALES DATA – DISCLOSE VALUE OF ITEMS LISTED IN TABLE B,
ITEMS 1‐15
If condition 1 applies, filer is subject to disclosure and a disclosure filing fee.
1. Conveyance date
:
_________________________________________________
(MM/DD/YYYY)
YES
NO
CONDITION
2. Total number of parcels:
_______________________________________________________
1. A transfer of real property interest for valuable
consideration.
3. Describe any unusual or special circumstances related to this
2. Buyer is an adjacent property owner.
sale, including the specification of any less‐than‐complete
ownership interest and terms of seller financing.
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.
YES
NO
CONDITION
(Provide the value
Table C Item 5.)
4. Family or business relationship existing between
10. Physical changes to property between March 1
buyer and seller?
and date of sale.
(Describe in special circumstances in Table C Item 3.)
Amount of discount: $
________________________________________
11. Partial interest.
(Describe in special circumstances in Table C Item 3.)
Disclose actual value in money, property, a service, an agreement, or other consideration.
12. Easements or right‐of‐way grants.
If conditions 1315 apply, filers are subject to disclosure, but no disclosure filing fee.
5. Estimated value of personal property: $
YES
NO
CONDITION
6. Sales price:
$
13. Document for compulsory transactions as a
YES
NO
CONDITION
result of foreclosure or express threat of
7. Is the seller financing sale? If yes, answer
foreclosure, divorce, court order, judgment,
questions (8‐13).
condemnation, or probate.
8. Is buyer/borrower personally liable for loan?
14. Documents involving the partition of land
9. Is this a mortgage loan?
between tenants in common, joint tenants, or
tenants by the entirety.
10. Amount of loan:
$
15. Transfer to a charity, not‐for‐profit organization,
11. Interest rate:
%
or government.
12. Amount in points:
$
13. Amortization period: