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STATEMENT OF BENEFITS <br />e <br />REAL ESTATE IMPROVEMENTS 20 _PAY20 <br />State Form 51767 (R21 1 -07) FORM SBA / Real Property <br />Prescribed by the Department of Local Government Finance <br />This statement is being completed for real property that qualifies under the following Indiana Code (check one box): <br />El Redevelopment or rehabilitation of real estate improvements (IC 6- 1.1- 12.1 -4) <br />© Eligible vacant building (IC 6- 1.1- 12.1 -4,8) <br />INSTRUCTIONS: <br />1. This statement must be submitted to the body designating the Economic Revitalization Area prior to the public hearing if the designating body requires <br />information from the applicant in making its decision about whether to designate an Economic Revitalization Area. Otherwise this statement must be <br />submitted to the designating body BEFORE the redevelopment or rehabilitation of real property for which the person wishes to claim a deduction. <br />Projects" planned or committed to after July 1, 1987, and areas designated after July 1, 1987, require a STATEMENT OF BENEFITS. (IC 6 -1.1 -12.1) <br />2. Approval of the designating body (City Council, Town Board, County Council, etc.) must be obtained prior to InlNaiion of the redevelopment or rehabilitation, <br />BEFORE a deduction maybe approved. <br />3. To obtain a deduction, application Form 322 ERAIRE or Fort 322 ERAIM, Whichever is applicable, must be tiled with the County Auditor by the later <br />of- (1) May 10; or (2) thirty (30) days after the notice of addition to assessed valuation or new assessment is mailed to the property owner at the address <br />shown on the records of the township assessor. <br />4. Property owners whose Statement of Benefits was approved after June 30, 1991, must attach a Form CF- 1/Real Property annually to the application to <br />show compliance with the Statement of Benefits. 11C 6-1.1- 12.1- 5.1(b) and IC 6 -1. f- 12.1 5.3U1 <br />S. The schedules established under 1C 6 -1.1- 12.1 -4(d) for rehabilitated property and under !C 6 -1.1 -12.1- 4.6(1) for vacant buildings apply to any statement <br />of benefits approved on or after July 1, 2000. The schedules effective prior to July 1, 2000, shall <br />July 1, 2000. cant<nue to apply to a statement of benefits filed before <br />Name of taxpayer <br />ss of taxpayer (number and street, city, state, and ZIP code) <br />)660 WoodbunLWay, Granger, IN 46530 <br />of contact person Telephone number <br />atrick Perrella (212) 495 -9196 <br />of South Bend Common Council <br />County <br />Bescri tion of real roe improvements, e t if <br />902 N. St. Peter Street <br />p property rtY p ,redevelopment, or rehabilitation {use addrtiona! sheets H <br />Clearance of site and construction of a single family home. <br />Current number [Salaries <br />Number retained <br />NOTE: Pursuant to IC 6 -1A- 12.1.5.1 (d) (2) the COST of the property <br />Is confidential. <br />Current values <br />Pius estimated values of proposed project <br />Less values of any property being replaced <br />Net estimated values upon completion of project <br />Estimated solid waste converted (pounds) <br />Other benefits <br />Satafts <br />REAL <br />COST <br />E -mail address <br />Resolution number <br />DLGF taxing district number <br />Estimated start date (month, day, year) <br />Estimated completion date (month, day, year) <br />03/30/2011 <br />Number additional Salaries <br />Estimated hazardous waste <br />Replacement of sidewalk and curb where required and paving of <br />that the <br />Signature <br />this statement are true. <br />Title <br />Page 1 of 2 <br />TE <br />VALUE <br />