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ADDENDUM SALES DISCLOSURE FORM
AGRICULTURAL OR RESIDENTIAL PROPERTY
State Form 57017 (R2 / 1 3-2 ) Original SDF ID
Prescribed by Department of Local Government Finance
Pursuant to IC 6-1.1-5.5
County Year Unique ID
INSTRUCTIONS: This form should only be used by assessing officials to modify or
note additional information about a sale that is identified after the original Sales
Disclosure Form has been submitted.
PRIVACY NOTICE: The telephone numbers and SSNs of the parties on this form are confidential according to IC 6-1.1-5.5-3.
PART 1
A. PROPERTY TRANSFERRED – Must be conveyed on a single conveyance document (Additional contiguous
properties can be listed on Page 5 of the underlying Sales Disclosure Form.)
1. Parcel Number or Tax Check all boxes 5. Complete Address of Property 6. Complete Tax Billing Address (if
Identification Number applicable to parcel. different from property address)
A.) ▢ 2. Split
▢ 3. Land
▢ 4. Improvement
7. Legal Description of Parcel:

B. CONDITIONS – Check only those that apply.
If condition 1 applies, filer is subject to disclosure and a disclosure filing fee. YES NO CONDITION
YES NO CONDITION
▢ ▢ 7. Easements or right-of-way grants. (Please
▢ ▢ 1. A transfer of real property interest for valuable note that: (i) public utility/governmental
consideration. easements; or (ii) rights-of-way that do not
▢ ▢ 2. Buyer is an adjacent property owner. transfer fee simple; do not require a sales
▢ ▢ 3. Vacant land (No structures on land) disclosure form. See the instructions for more
information.)
▢ ▢ 4. Exchange for other real property (“Trade”) If conditions 8-10 apply, filers are subject to disclosure, but
Parcel number of traded property: ___________________ not to the disclosure filing fee.
▢ ▢ 5. Land contract. ▢ ▢ 8. Document for compulsory transactions as a
Contract term (YYYY-YYYY): _________________ result of foreclosure or express threat of
foreclosure, divorce, court order, judgment,
Contract date (MM/DD/YYYY): ________________ condemnation, eminent domain, or probate.
▢ ▢ 6. Partial interest. Describe: ________________________ ▢ ▢ 9. Documents involving the partition of land
between tenants in common, joint tenants, or
_____________________________________________ tenants by entirety.
_____________________________________________ ▢ ▢ 10. Transfer to a charity, not-for-profit
organization, or governmental entity or agency.

C. TRANSACTION DETAILS – Complete only those that apply.
YES NO CONDITION YES NO 6. Transaction includes multiple Sales Disclosure Forms?
▢ ▢ 1. Sheriff Sale or Tax Sale ▢ ▢ SDF Form ______ of ______
▢ ▢ 2. Short Sale 7. Date conveyance document signed (MM/DD/YYYY): ____________
▢ ▢ 3. Quitclaim Deed 8. Days property was on the market: __________________________
▢ ▢ 4. Auction 9. Total number of parcels on this disclosure: ____________________
5. Other: _________________________________________ (If there is more than one (1) parcel, See Page 3.)
_______________________________________________ 10. Select the type(s) of property below and fill out corresponding page(s).
_______________________________________________ Check all that apply.
_______________________________________________
_______________________________________________ Agricultural ▢ Residential
▢
_______________________________________________

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D. SALES DATA – Complete only those that apply.
▢ Information contained in question 3 is confidential and non-disclosable under IC § 5-14-3-4.
 YES NO        CONDITION                                                3. Planned use of the property?
 ▢   ▢         1. Changes to the property between Jan. 1 and sale date? Describe: __________________________________
               Describe: ______________________________________         __________________________________________
 ▢   ▢         2. Property is a residential rental property.            __________________________________________

E. FINANCE DATA – Complete only those that apply.
1. Sales Price:   ____________________________________              YES NO CONDITION
2. Personal Property included in transfer. Amount:  _____________   ▢   ▢  6. Is the seller financing the sale? (If yes,
                                                                           answer questions 7-8.)
3. Seller paid points/closing costs.  Amount:  __________________
4. Existence of family or business relationship between the buyer   ▢   ▢  7. Is buyer/borrower personally liable for loan?
and the seller.  Amount of discount (if any): $ __________________  ▢   ▢  8. Is this a mortgage loan?
5. Describe any less-than-complete ownership interest and terms     ▢   ▢  9. Was an appraisal done?
of seller financing. _______________________________________

RELIGIOUS USE  ROPERTY P AX TXEMPTIONE
Is the property being transferred going to continue to be used by a church or religious society      YES          NO 
for the same property tax exempt purposes provided by IC 6-1.1-10-21(e)?                             ▢            ▢

F. ADDITIONAL INFORMATION
1. Physical changes to the property identified 2. Identify any additional special circumstances or information relating to the
after the submission of the original Sales     sale identified after the submission of the original Sales Disclosure Form:
Disclosure Form: _________________________     ______________________________________________________________
________________________________               ___________________________________________________
________________________________               ___________________________________________________
________________________________               ___________________________________________________
________________________________               ___________________________________________________
                                               ___________________________________________________
          Assessor Stamp                       ___________________________________________________
                                               ___________________________________________________
                                               ___________________________________________________
                                               ___________________________________________________
                                               ___________________________________________________ 
                                               ___________________________________________________
                                               ___________________________________________________
                                               ___________________________________________________ 

Assessor Name (Printed)                        Assessor Signature                               Date (mm/dd/yyyy) 

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SALES DISCLOSURE PART 1(A)
State Form 55632 (R / 1-21) SDF ID
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. County Year Unique ID
Do NOT place personally identifiable information (e.g. consulate
numbers, passport numbers; government ID numbers, etc.) on this form
as it may become publicly available.

PART 1 – To be completed by BUYER/GRANTEE and SELLER/GRANTOR
A. PROPERTY TRANSFERRED – Must be conveyed on a single conveyance document.
(Multiple parcels can be listed on this form and attached to State Form 46021 only if they are contiguous and
located entirely within a single taxing district.)
1. Parcel Number or Tax Check all boxes 5. Complete Address of Property 6. Complete Tax Billing Address (if
Identification Number applicable to parcel. different from property address)
B.) ▢ 2. Split
▢ 3. Land
▢ 4. Improvement
7. Legal Description of Parcel B:

C.) ▢ 2. Split
▢ 3. Land
▢ 4. Improvement
7. Legal Description of Parcel C:

D.) ▢ 2. Split
▢ 3. Land
▢ 4. Improvement
7. Legal Description of Parcel D:

E.) ▢ 2. Split
▢ 3. Land
▢ 4. Improvement
7. Legal Description of Parcel E:

F.) ▢ 2. Split
▢ 3. Land
▢ 4. Improvement
7. Legal Description of Parcel F:

G.) ▢ 2. Split
▢ 3. Land
▢ 4. Improvement
7. Legal Description of Parcel G:

H.) ▢ 2. Split
▢ 3. Land
▢ 4. Improvement
7. Legal Description of Parcel H:

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