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3 �•°•'•a APPLICATION FOR DEDUCTION FROM ASSESSED VALUATION 20 18 y OF STRUCTURES IN ECONOMIC REVITALIZATION AREAS (ERA) RE a 11' State Form 16379(R1416-16) > Prescribed by the Department of Local Government Finance INSTRUCTIONS: 11 `t 1. This form is to be filed in person or by mail with the County Auditor of the county in whI' erty is IoC 2. To obtain this deduction,a Form 322/RE must be filed with the County Auditor befor ft 10 in yearn wf i� addition to mailed e after valuation 1 o If the o if it new assessment)is made,or not later than thirty(30)days after the assessment not' mailed to tpppp,d� p y property owner misses the May 10 deadline in the Initial year of assessment,he ca ®pply bet1AIJ1 d 10 of a subsequent year for the remainder of the abatement term. (See also 1C 6-1.1-12.1-11.3 concerning the faflu file a tlk?118811y application.) 3. A copy of the Form 11,the approved Form SB-1/Real Property,the resolution ado by the desiRrttAtbody-any Form CF-1/Real Property must be attached to this application. r 1vo Ca9tin 4. The Form CF-1/Real Property must be updated annually and provided to the Coun ditor and�tf 7 afin � for each assessment year in which the deduction is applicable. 5. Please see IC 6-1.1-12.1 for further instructions. 6. Taxpayer completes Sections 1,11 and 111 below. 7. If property located in an economic revitalization area is also located in an allocation area as define In 36-7-14-39 or IC 36-7-15.1-26,an application for the property tax deduction may not be approved unless the Commission that designated the allocation area adopts a resolution approving the application (IC 6-1.1-12.1-2(k)). 6. redevelopment t fordeductions related a d to redevelopment a may habih be approvreal r th property low/ng facifit/es(IC 6 9.1 consolidated city,a deduction for the a. Private or commercial golf course j. Any facility,the primary purpose of which is(a)retail food and beverage service;(b)automobile sales or service;or(c)other retail;(unless the b. Country club facility is located in an economic development-target area established c. Massage parlor under IC 6-1.1-12.1-7). d. Tennis club k. Residential,unless the facility is a multi-family facility that contains of modrate income e. Skating facility,including roller skating,skateboarding or ice skating least 20%of the unit the habit for located In an economec development f. Racquet sport facility(including handball or racquet ball court) target area established under IC 6-1.1-12.1-7,or the area is designated g. Hot tub facility as a residentially distressed area which is required to meet conditions as h. Suntan facility cited in IC 6-1.1-12.1-2(c)(1&2). i. Racetrack 1. Package liquor store(see IC 6-1.1-12.1-3(e)(12)) SE0710N I: DESCRIPTION,b PROPERTY The owner hereby applies to the County Auditor for a deduction pursuant to IC 6-1.1-12.1-5 beginning with the assessment date January 1,20_L7 . County Township DLGF taxing district numhnr Key number 71-03-16-401-001.000-0091 0251010.017664 St. Joseph County German B German 71 -009 Name of owner Legal description from Form 11 James A. Masters and Nancy J. Masters Lot 46 The Villas at Lake Blackthorn Sec 1 04/05 New Replal Trans 1955 4/21/03 Date of Form 11(month,day,year) Property address(number and street,city,state,and ZIP code) 7/21/2017 5015 Masthead Court, South Bend, Indiana 46628 use of structure Type of structure Residential Home Detached single family home Governing body that approved ERA designation Date ERA designation approved(month,day,year) Resolution 4295-1 3 South Bend Common Council November 11, 2013 s r r -C tQJJrQF�g1NNER,OR; EPRESENTATIVE- `' Date signed(month day,/ear) Signal own or represent rve(1 hereby certify that the rep se afions on this application are true.) November�, 201 7 F. ~�� A dress number and street,city,state,and ZIP code) rinted ma of owner or representative James A. Masters/Nancy J. Masters 5015 Masthead Court, South Bend, IN 46628 AUDITOWS r. :: �. .t:.A.Rehabilitation structure I.Assessed valuation AFTER rehabilitation $ - 2. Assessed esse d vat nation BEFORE RE rehabilitation $ 3.Difference in assessed valuation(Line 1 minus Line 2) $ -- 4.Assessed valuation eligible for deduction $ (for the increase in AN from the rehabilitation,not Including the increase in AN from the reassessment of the entire structure) $ 329,900-00 B.New structure 1.Assessed valuation $ 329,200.00 2.Assessed valuation eligible for deduction _ { -.:?J 1 « l(kRIPI 'G�OIV�at=�sSESSING QFFICIAL I verify that the above described structure was assessed and the owner was notified on with the effective date of the assessment being January 1,20 ,and that the assessed valuations in Section III are correct. Signature of assessing official Printed name of assessing official Date(month,day,year) Page i of 2