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'-Oad in Clerk's Off lea <br /> STATEMENT OF BENEFITS _. 20 PAY 20_ <br /> REAL ESTATE IMPROVEMENTS <br /> State Form 51767(R6 I i 0-14) —' ) � � FORM SB-1 f Real Pfopefty <br /> Prescribed by the Department of Local Government Finance iI PRIVACY NOTICE <br /> This statement is being completed for real property that qualifies under the following Inldiatlta Fd'd4 eh7h 1fiAtskj I Any information conceming the cost <br /> Redevelopment or rehabilitation of real estate Improvements IC li 1.1-12. t E { of the properly and specific salaries <br /> p Pr ( ..Ti i C� {, } I iND,Ct�i paid to individual employees by the <br /> Residentially distressed area(1C 6 1.1-12.1-4,1) property owner is con <br /> Fldentiai per <br /> ^y� IC 6-1.1-12.1-5.1. <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 orrehabilitation ofreal property for which the person wishes to claim a deduction. <br /> 2. The statement ofbenefits form must be submitted to the designating body and the area designated an economic revitalization area before the initiation of <br /> the redevelopment or rehabilitation for which the person desires to claim a deduction. <br /> 3. To obtain a deduction,a Form 3221REmust be filed with the County Audiforbefore May 10 in the year in which the addition to assessed valuation is <br /> made or not later than thirty(30)days after the assessment notice is mailed to the property owner if it was mailed afierApol 10. A property owner who <br /> failed to file a deduction application within the prescribed deadline may file an application between March 1 and May 10 of a subsequent year <br /> 4. A property owner who files for the deduction must provide the CountyAud(torand designating body with a Form CF-I/Real Property. The Form CF-1/Real <br /> 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. <br /> IC 6-1.1-12.1-5.1(b) <br /> 5. For a Form 3B-11Real Property that is approved after June 30,2013, the designating body is required to establish an abatement schedule for each <br /> 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 <br /> remains in effect. iC 6-1.1-12.1-17 <br /> SECTION •' • <br /> Name of taxpayer <br /> Historic Lincoln Way West Homes, L.P. (a to be formed limited partnership) <br /> Address of taxpayer(numberand street city stale,and ZIP code) <br /> 803 Lincoln Way West,South Bend, IN 46616 <br /> Name of contact person Telephone number E-mail address <br /> 322 ( ) <br /> SECTION 2 LOCATION AND DESCRIPTION OF PROPOSED PROJECT <br /> Name ofdesignating body Resolution number <br /> Location of property County DLGF taxing district number <br /> $0 <br /> Description of real property improvements,redevelopment,or rehabilitation(use additional sheets ifnecessary) Estimated start date( onth day,year) <br /> 5/1/2019 <br /> Conversion of a former brewery building into 22 residential apartments. Estimated completion date(month day,yeah <br /> 5/1/2020 <br /> Curcant number Salaries Number retained Salaries Number additional Salaries <br /> No permit issued 1 $40,000 <br /> REAL ESTATE IMPROVEMENTS <br /> COST ASSESSEDVALUE <br /> Currentvalues 1$ 125,000 $ 120,600 <br /> Plus estimated values ofproposed project 1$6,404,000 $ 1,430,000 <br /> Less values of any property being replaced -0- -0- <br /> Net estimated values upon completion of project S6,529,000 1,550 600 <br /> Estimated solid waste converted(pounds) Estimated hazardous waste converted(pounds) <br /> Other benefits <br /> -Improvement of a deteriorated property on a major arterial road that leads from the airport to downtown South Bend.TAXPAYER CERTIFICATIN <br /> SECTION <br /> • <br /> I hereby •itify that th re sNn t tions in this statement are true. <br /> Signature a re s fa a Date signed(month,day,year) <br /> July 2,2018 <br /> Printed name c authorized rqtlfa v d�'J\'7 Title I <br /> Marco Mariani,Exe utl a Director Executive Director <br /> Page 1 of 2 <br />