State Form 46021 - Sales Disclosure Form Page 3
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13INDIANA 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. Property
2. AV Land
3. AV Improvement
4. Value of Personal
5. AV Total
6. Property
7. Neighborhood
8. Tax District
9. Acreage
Property
Class Code
Code
A.)
B.)
YES
NO
CONDITION
Assessor Stamp
10. Identify physical changes to property between March 1 and
date of sale. _____________________________________________________________
11. Is form completed?
____________________________________________________________________________
12. State 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
NO
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
NO
CONDITION
Auditor Stamp
1. Disclosure fee amount collected: $__________________________________
6. Is form completed?
2. Other Local Fee: $____________________________________________________
7. Is state 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 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)
Check all that apply:
______________________________________________________________________________________________
City, State, and ZIP Code of Property
Homestead
Solar Energy
Wind Power
______________________________________________________________________________________________
Auditor Signature
Date
Hydroelectric
Geothermal
Rental Property
(MM/DD/YYYY)
Electronic Statement (e‐mail)______________________________________________
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.
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