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STATEMENT OF BENEFITS ' <br />REAi. ESTATE IMPROVEMENTS <br />Slate Form 61787 (Re 110 -14) <br />Pmscribedby1haDeparim,entofLooWGovemment <br />This stalelnenl is beln8 completed for real property that'qua)lges under <br />�II Redevelopment or rehablillalloh of root estate Improvements 00 0- <br />t]Residentlally distressed area #0 61.1- 12.1 -4.1) <br />1AgTRU0W0AfS; <br />9. 7hfsatatemantmust hesubmllledto the bol deslgnathtglite Ecor <br />frrroh allon lrom the appiloantin making it s olsion about whether <br />submitted to thedesfgnalingbodyRIEFOREfile redevelopment art <br />z 7be statement ofbeneNs form must be submitted to the dealgnagg <br />the redeye . ment ormlieWlellbn for whkh!he parson dashes to i <br />3. To obtalu s eddelim, a Form =REmust be tiled with the Counti <br />made "not laterthen thlrfy (30) days after" assessment nofke 1 <br />felled to.16 a deduction appflcefim wiffiln the preaedbed deadihle n <br />4. Apropedyowner who Res for the deduction must provide the Coon <br />Pmdpeify'should be attached to the Fomr 322/RE man file cieducik <br />" " G. For a t'oini3`D�IReaI Pioperty th`af )s approved oiler June 30, 2 <br />Filed in Clerk's Office <br />SEP 0`8 2016 <br />20 PAY 20` <br />FORM 8121-11 Real property <br />PRIVACY OWE <br />Apy Informalton eerjcem ng file cost <br />of the pro end epee la ss�es <br />P-914-1 ival emploYaea by the <br />pprreoppee��tyyoo��vAeriecon0 apdalper <br />.19 6:1.'f :12.1•b.1. <br />Is <br />& r ytilroid to eslabNsh -an ebelemenl schedule for each <br />e abatement schedule approved by the designallog body <br />- <br />e• o <br />Name of lexpayer <br />Imagineering Enterprises, Inc. <br />Address of lexpayertnumberandskest 41K state, srrd ZIPcodo) <br />1302 W. Sample Street; South Bend, Indiana 46619 <br />Na"Olca nfectperson <br />Telephone number <br />Emd address <br />Joseph Rowan <br />( 574 ) 807 -8723 <br />jjrowanQIftww.corn <br />SECTION e s e <br />o N'OF PROPOSEbiPROJECT <br />Nameofdsslyna y <br />Resolution Number <br />South Bend Common Council <br />TBD <br />a ono props y <br />Colntly <br />DLBF taxing disblatnumber <br />3722 Foundation Court; South Bend, Indiana 46628 <br />St..Joseph <br />71 009 <br />Deaorlptionof rest plopwl "rovements, redevelopment, orrehd ililation(ysea onalshaesfnecebaery <br />Estimaledsiaridale(monA dog yea4 <br />Ootober 15, 2016 <br />Building Oddltign of approximately 8,000 square feet. <br />15slkiialedeohlpleyan dete0""A day, year) <br />April' 15, 2017 <br />0 r N11 EST] V, ATE�QFi EMP LC DIS'AL <br />o ••o•o S EIDIP -e <br />corrontmum6er Baledea Numberretalned <br />Sshutes Namberaddltiortet Salaries' <br />135 5,773,000 135 <br />5 773 000 25 <br />1780.000 <br />e o a <br />- o o s o <br />HEAL ESTATE IMPROVEMENTS <br />COST <br />ASSESSEDVALUE <br />current values <br />11.9DO.000 <br />1 480 500 <br />Plu$asllmatedvalues of prwsed prillect <br />500,000 <br />TS <br />Less values ofmilly prdperly bding replitcdd <br />Netasitmated values 00—OYLODIM IeUon of et <br />2 400 000 <br />TBD <br />a s s <br />s e s: <br />Eathnated'solid waste converted (pounds) <br />Esllmated hazardous waste converted (pounds) <br />Oflterkensllis <br />SECTION 6 TAXPAYER CERTIFICATION <br />hereby oettity that the representations in this statement are true. <br />Signilurs ofeulhodsed represealaWs <br />::1 <br />Dale algpeil <br />tmonay.day,, year) <br />(=, " I ---rl> <br />. <br />-1 '7: <br />1 2olte <br />,&.= e reprsenlaave <br />printed ifer of I <br />TNe " <br />Joseph Rowan <br />JCFONP of Finanbe <br />Pagel of 2 <br />