Fulton County Auditor

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Sales Disclosure Form

State Form 46021 (R11/12‐11) Prescribed by Department of Local Government Finance Pursuant to IC 6‐1.1‐5.5
PRIVACY NOTICE: The telephone numbers and Social Security numbers of the parties on this form are confidential
according to IC 6–1.1–5.5–3(d).

SDF ID
County
Year
Unique ID
SDF Date (mm-dd-yyyy)
Sales Disclosure Form Instructions

PART 1 – To be completed by BUYER/GRANTEE and SELLER/GRANTOR
A. PROPERTY TRANSFERRED – MUST BE CONVEYED ON A SINGLE CONVEYANCE DOCUMENT
Property Number (A)
Check box if applicable to parcel
      
Complete Address of Property
Complete Tax Billing Address (if different from property address)
Legal Description of Parcel A
Property Number (B)
Check box if applicable to parcel
      
Complete Address of Property
Complete Tax Billing Address (if different from property address)
Legal Description of Parcel B
B. CONDITIONS – IDENTIFY ALL THAT APPLY

If condition 1 applies, filer is subject to disclosure and a disclosure filing fee.

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 right‐of‐way grants.

If conditions 13–15 apply, filers are subject to disclosure, but no disclosure filing fee.

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, not‐for‐profit organization, or government.
C. SALES DATA – DISCLOSE VALUE OF ITEMS LISTED IN TABLE B, ITEMS 1-15
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 less‐than‐complete ownership interest and terms of seller financing.
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.
5. Estimated value of personal property:
6. Sales price:
7. Is the seller financing sale? If yes, answer questions (8-13).
8. Is buyer/borrower personally liable for loan?
9. Is this a mortgage loan?
10. Amount of loan:
11. Interest rate:
12. Amount in points:
13. Amortization period:
D. PREPARER
First Name
Last Name
Title
Address (Number and Street)
Company
City
State
ZIP
Telephone Number
E-mail
E. SELLER(S)/GRANTOR(S)

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 6–1.1–5.5, "Real Property Sales Disclosure Act".

Seller: Name as appears on conveyance document
Address (Number and Street)
City
State
ZIP
Telephone Number
Email
Signature of Seller
Sign Date (mm-dd-yyyy)
Printed Name of Seller
F. BUYER(S)/GRANTEE(S) – APPLICATION FOR PROPERTY TAX DEDUCTIONS – IDENTIFY ALL ITEMS THAT APPLY

THE SALES DISCLOSURE FORM MAY BE USED TO APPLY FOR CERTAIN DEDUCTIONS FOR THIS PROPERTY. IDENTIFY ALL OF THOSE THAT APPLY.

1. Will this property be the buyer's primary residence? Provide complete address of primary residence, including county:
Address (Number and Street)
City, State ZIP Code
County
2. Does the buyer have a homestead in Indiana to be vacated for this residence? If yes, provide complete address of residence being vacated, including county:
Address (Number and Street)
City, State ZIP Code
County
3. Homestead
4. Solar Energy Heating/Cooling System
5. Wind Power Device
6. Hydroelectric Power Device
7. Geothermal Energy Heating/Cooling Device
8. Is this property a residential rental property?
9. Would you like to receive tax statements for this property via e-mail? (Provide contact information below. Please see instructions for more information. Not available in all counties.)
Primary property owner contact name
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 6–1.1–5.5, "Real Property Sales Disclosure Act". (Note: Spouse information, Social Security and Driver's License/Other numbers are not necessary if no Homestead Deduction is being filed.)

Buyer: Name as appears on conveyance document
Address (Number and Street)
City
State
ZIP
Telephone Number
Email
Last 5 digits of Buyer 1 Driver's State
Last 5 Digits of Social Security Number
Signature of Buyer
Printed Legal Name of Buyer
Sign Date (mm-dd-yyyy)
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 Property
5. AV Total
6. Property Class Code
7. Neighborhood Code
8. Tax District
9. Acreage
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)
Assessor Stamp

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

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
1. Disclosure fee amount collected:
2. Other Local Fee:
3. Total Fee Collected:
4. Auditor receipt book number:
5. Date of transfer (mm-dd-yyyy)
6. Is form completed?
7. Is state fee collected?
8. Attachments complete?
PART 4 – RECEIPT FOR STATEMENT OF DEDUCTION OF ASSESSED VALUATION
SDF ID
SDF Date (mm-dd-yyyy)
Parcel Number
Check all that apply:
              
Buyer 1 - Name as appears on conveyance document
Address of Property (Number and Street)
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.
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