18-18 Designating Property Tax Abatement Petition - Franklin Street Technology Park, LLC

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STATEMENT OF BENEFITS Filed in Clerk's Office 20_PAY 20_ REAL ESTATE IMPROVEMENTS State Form 51767(R6/10-14) FORM SBA I Real Property Prescribed by the Department of Local Government Finan a MAR 2 9 2018 PRIVACY NOTICE This statement is being completed for real property that qualifies under th followi Indiana Code check one box): Any information concerning the cost p ( ) KAREEMAH FOWLER of the property and specific salaries [Z Redevelopment or rehabilitation of real estate improvements IC 6-1.1- 2.1-4 paid to individual employees by the ❑Residentially distressed area(IC 6-1.1-12.1-4.1) CITY CLERK,SOUTH BEND IN property owner is confidential per + IC 6-1.1-12.1-5.1. INSTRUCTIONS: 1. This statement must be submitted to the body designating the Economic Revitalization Area prior to the public hearing if the designating body requires information from the applicant in making its decision about whether to designate an Economic Revitalization Area. Otherwise,this statement must be submitted to the designating body BEFORE the redevelopment or rehabilitation of real property for which the person wishes to claim a deduction. 2. The statement of benefits form must be submitted to the designating body and the area designated an economic revitalization area before the initiation of the redevelopment or rehabilitation for which the person desires to claim a deduction. 3. To obtain a deduction,a Form 3221RE must be filed with the County Auditor before May 10 in the year in which the addition to assessed valuation is made or not later than thirty(30)days after the assessment notice is mailed to the property owner if it was mailed after April 10. A property owner who failed to file a deduction application within the prescribed deadline may file an application between March 1 and May 10 of a subsequent year 4. A property owner who files for the deduction must provide the County Auditor and designating body with a Form CF-11Real Property. The Form CF-1/Real Property should be attached to the Form 3221RE when the deduction is first claimed and then updated annually for each year the deduction is applicable. iC 6-1.1-12.1-5.1(b) 5. For a Form SB-1/Real Property that is approved after June 30, 2013, the designating body is required to establish an abatement schedule for each deduction allowed. For a Form SB-1/Real Property that is approved prior to July 1, 2013, the abatement schedule approved by the designating body remains in effect. IC 6-1.1-12.1-17 SECTION 1 TAXPAYER.INFORMATION Name of taxpayer Franklin Street Technology Park LLC Address of taxpayer(numberand street,city,state,and ZIP code) 814 Marietta Street South Bend, IN 46601 Name of contact person Telephone number E-mail address Anne Hayes ( 574 ) 233-1296 ahayes @telecompark.corn • • . Name of designating body Resolution number Location of property County DLGF taxing district number 900 Franklin Street St Joseph Description of real property improvements,redevelopment,or rehabilitation(use additional sheets if necessary) Estimated start date(month,day,year) SEE ATTACHED July 2018 Estimated completion date(month,day,year) July 2022 Cu 0.rent number Salaries Number retained Salaries Numberadditional Salaries 00 0.00 REAL ESTATE IMPROVEMENTS COST ASSESSED VALUE 84,040.00 Current values Plus estimated values of proposed project s,000,000.00 Less values of any property being replaced Net estimated values upon completion of project 3,084,040.00 Estimated solid waste converted(pounds) Estimated hazardous waste converted(pounds) Other benefits SECT • CERTIFICATION I hereby certify that the representations in this statement are true Signature of authorized represen L Date signed(month,day,year) i 03/28/2018 ted name f authorized represe Title Anne Hayes Member Page 1 of 2 I