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STATEN' E1 " OF ENEFITS <br />REAL ESTATE II�pROVEMENTS <br />Slate Form GiV7 (Re 110:14) <br />Presodhed by the Department of Lopal Govern <br />Thle statement Is be" completed for rdal property Ihallquallhe <br />Redevetopinent 0 rehablllialtoh of real eptate lInprovementi <br />(� Reaidenllally d(siressed area (IC 0 -i.i- 12.1 -4,1) <br />IMTRUCTIONS. <br />1. ihostai meotmustbesubinxedtoIliabodydes &natlwtl, <br />Ihf!h allrin from the appgcantin ma*gIts dedslon abouta <br />sujimllledio thedeslgne It, igbodyBEFOREIIie mdetretopm_... _ <br />2. The statement o /benefits form must be suhnrliled to Ilia deslpalpgboay end the arse deaalppialed ern econoimlo.r walizallon area before Me hiftle fti of <br />fimWevelopmenl ormhoUltetlon forwhtahtbe person deahes to Balm a deduction. - <br />3, T.o'obfiA a deddWon, a Form 3221RE must be flied wOh the CounlyAudiforbe %a May 10 hr the yearn Witch the addfllon to assessed Wollon Is <br />made or( wtlaledhanthhtyf30daysagerUreassessmentnollo okna)ledtoMe yoWner10wesmaliedatlerApV10L Apropertyownerwhp <br />falfed 16.4 a deductlon sppf , n w0hin fhe presonbod deadlinemayMean appfoallon betwom March 1 end May 10 ola subsequent year <br />4• A- rupedymijap rwho gas fortie deduction mus tprovideMaOountyAud1armnddes4;naling body w0ha Form CF-7lRea !Property. 77reFWmCr--1/Rea1 <br />leduatbnls first afalmecfand then updated ahnualtyforeadi year the deduction Is appNcabla. <br />e 30, 7013, Mhe eslgnamitlfg'baW "I -m—cla Old �StabNal► art �tislemenF schedule -for eadf - <br />approved prior to July 1, 2013, the abatemeril schedule approved by Via designall►tg body <br />9.1. <br />Piled In Clerk's Of fte <br />SEP 10 201 f <br />20 PAY 26 <br />FORM 0041l;eal Property <br />RIVA O <br />Air Gfformalkd cbrjcprV the wst <br />o f ro pa�ndep��eppcyys��lo ak�a <br />o bratyW��i lsoomdfiifdao$af6ylka pbr <br />. C'�9.1 <fz•1s.1. <br />Prrpelly <br />0 <br />0• a <br />Mameoftexpayer <br />Imagineertng Enterprises, Inc. <br />Address of taxpayer fnamberardaboet dU stele, a rtf aPCOda) <br />1302 W. Sample Street; South Bend, Indiana 46619 <br />Wine of Contact person <br />'telephone number <br />E-Ind address <br />Joseph Rowan <br />. .... <br />1( 674) 807 -8723 <br />jrMrQiftww.com <br />L SECION12 0 0 e <br />O • •0 0 <br />amuse e- salsOnp dy <br />Reeotu0onmmber <br />South Bend Common Council <br />TBD <br />Locallm of propeiW <br />DI.OFlaxingdlsMnumber <br />3722 Foundation Court; South Bend, Indiana 46628 <br />Ist..40seph <br />71009 <br />Re p of jW property tmprovemenls,redevebpmerA,orreha Alta (u.sOaddKonitisheals <br />ffmmssery <br />EaDmatedslart dais (monlitftyear) <br />Ootober 15, 2016 <br />Building �ddlggn of apprgxlmately 8,000square feet. <br />Ee6rtigleaedidplelbn dete(montl6ddSSyesr) <br />Apt1t 15, 2017 <br />s o e <br />o o•a <br />Cyrrentnumber 8nladea Numberrotailed <br />Sakdes NumberaddWonal 811111fes' <br />735 5,7731000 135 <br />5,773.000. 2 <br />780,000 <br />a <br />e o e 1111111WHIIIIIIIN o <br />REAL ESTATE IMPRAVEMENra <br />OUST <br />ASSESSEDVALUE <br />currsntvaluua <br />1900 0 <br />1480 500 <br />OJ4.esWrWtedvsIqqs ofproposedprojecl <br />5W.000 <br />TB11 <br />LssA values of a rd art 'bd replaW <br />Not alitin aced. values u n elidri bf o- ct : <br />2 40D 000 <br />D <br />0 <br />1 sWnsted rplld waste converted (pounds) . <br />Esfinated hazerdous waslenmwer(ed (goods) <br />Olherltanallls <br />I hereby oertify that the representations In oft statement are true. <br />.Slpm4ftofaulpit- drepreaet1WWO <br />otda!tJ OWA. 04Y ! <br />gly <br />pt r b.-n df rwas"WA <br />Jtisepi ipjyan <br />CFO/VP of Fifianbe <br />Page i ol2 <br />