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TpTi =MENT OF BENEFITS <br />REAL ESTATE {MPROVEMEN7S <br />State Foam 51767 (R6! 16.14) <br />Pres's #xd by the mparbnent of Local Government Flnanoe <br />TMs siaterdent Is being completdd for realpropedy thatgdallfles under the follow <br />0 Redevelopment or rehikWillon of real estate Improvements (10 6-1.142.1-4) <br />[11joidgngalty dis(resseit area (10 0- 1.142,14.1) <br />F11W in Clwkts Ofte <br />SEP W8 2010 <br />K4WWJ fAN FDVVUM <br />w <br />20,6 PAY 20 <br />FO);M 3041 Real Ptoptuty <br />PRIVACY NOTWE <br />InfotrrmtbaeaneerotrMAO coal <br />of the p ead apeellle aeladea <br />paWlo of d�Atlu�l empp�Iooyyaea w the <br />properly ownwta dobfldenllblpat <br />IC &1.1- 12.1-6.1, <br />1. fitsstatemertimustbesubmHtedtothe , deslgnaUagt heEconorafc( i. WaRaWaAneaptlortoalepucuctwangtrtneopagnauggracaytegagr qs <br />1hffi la*ffWftomthesppiicanthlmaAVft 14) bnabout oleiirerlodesigru�teaitEconoinkRoWakagmAre.o 01henvlse, INS stetpmentmostbe <br />subm/(fedtofilede lingbodyEFFOJ4EMemdevelopmet )tarrehabNllat (ono /realproparryforwhkdi haparaonwlshes3oc laimabedtrotlo» <br />2. 777e 4tateMsntgfbensR; roan must be submitted to the dasighaNngbodyand -0 aria ditwfed ari econdtnk ievNd&81lon area befoul the hhltiatton of <br />Me redevskVpent ortaltablN eon for whkh the person dukes to dahn a deduction. <br />3. Toobldki a deddefhtd, a tzamf 322%RE must be filed with the CouafyAuditorbefore May 901E the year ht Whkh Me.sddh*n to assessed vatuaflon Is <br />nisdo ornotlaierthan iblZ f3? days afterthe assessment nolks k malted to fhe propWyowner #It was mAd abrApril10 Apropedy owner who <br />farted M Mb a deducion epp sa ida x9f Riff spresodbed desdlins may gig an appAcaljmn behown March 7 ilndMay 1,0 of a su4sequenl year <br />4. Aprope dypwerxfiokes3 orfhededudlonmusfprovidpa CounikAud/ oraddegnafiVboywAafonCF- 1/Realliroperfy. <br />The FormCF- 1/Rebt <br />Phaperfyshoutd be attached to fhe Form 322/l#E when the deduction is Ifat cklmerf andthen &plated annually for each year the deduction is applicable <br />>C &1.1- 12,IAit(b) <br />E For a f6m) S &Iffluf Pxpe$y that 4 approved after June 30, 2013, the, des"aft body is requked tq establish en abskment schedule for each <br />dedh ;that ifted For a Airm S13- 11Re81 Fatty that is approved prior 10 July 1.201 the abatement schedule approved ay the designating botfy <br />'reina)»aind&fft- 1016- 1.112.1 -17 <br />SECII ON •- <br />Nama of I�payar' <br />INDUSTRIAL•MaAL FAB, ANC. <br />Wags ojlapn_wqr(MT"rWdq@84 ew a". qnda wde) <br />2806 WESTSAMPLE, SOUTH BEND, IN 46619 <br />Name of contact person Telephone number <br />Smell addreaa <br />PATRICK FOR -OR- KYLE EVFAUDWAY : (574 ) 288 -836$ <br />PFOX @IMFONLINE.COM <br />e .. 10N O�_ PROPOSED PR,7).JFC1 <br />meat mSnO • • y <br />Reaohhibn number <br />Lootipaefproperty <br />Ceun!r <br />OF faxlrO dlsvtct mmiber <br />2866. WEdT:SAMPLE, SOUTH BEND, IN 46619 <br />ST. JOSEPH <br />Descrfptprhpf real pfcpa:rly MppW_wnts. r 1, or bWtaaoe (use ad,Bfonar_ ek ffnar essay) <br />E.Umated slam date ow^ dey.Yead <br />kC1drh ss L0404;' dO� a�ci iss uh5 WtNU UrAcrOe 4 ok'yu.cris . I • <br />'nAa4d4etl (rletAcltMg5 eel fWw%+ (fowks) . ftmwg; dt_jt4ov�t p4te taa*v1. <br />1.0-15 -2016 <br />Es*WAdwmp"ndwe0 -4& <br />.it .A -LO S.fet_( tw-,l :ir1 tror .s AAac1 <br />110-15-2018 <br />n......., •,,..r.:, s•h•,t.. Nunbefrabbod Satedae NwnW&ddOonW <br />Sfili es <br />Page 1 of 2 <br />