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Filed in Clerrkk'ss-Office I <br /> STATEMENT OF BENEFITS LIAR 2 9 2019 l <br /> 2020 PAY 2021 <br /> ` '"'"'f"fj REAL ESTATE IMPROVEMENTS __ <br /> State Form 51767(R6/10-14) I KAREEMAH FOWLER FORM SB-1/Real Property <br /> Prescribed by the Department of Local Government Finance C�j1Y CL ERK,c ' <br /> �U r BEND, IN PRIVACY NOTICE <br /> This statement is being completed for real property that qualifies under the following Indiana Code(check ohe boxy- Any information concerning the cost <br /> Redevelopment or rehabilitation of real estate improvements(IC 6-1.1-12.1-4) or the property and specific salaries <br /> p p paid to individual employees by the <br /> ❑Residentially distressed area(IC 6-1.1-12.1-4.1) property owner is confidential per <br /> 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 or rehabilitation of real property for which the person wishes to claim a deduction. <br /> 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 <br /> the redevelopment or rehabilitation for which the person desires to claim a deduction. <br /> 3. To obtain a deduction,a Form 322/RE must be filed with the County Auditor before 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 after April 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 County Auditor and designating body with a Form CF-1/Real Property. The Form CF-1/Real <br /> Property should be attached to the Form 322/RE 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 SB-1/Real 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 1 TAXPAYER INFORMATION <br /> Name of taxpayer <br /> CATALYST THREE LLC <br /> Address of taxpayer(number and street,city,state,and ZIP code) <br /> 112 WEST JEFFERSON BLVD., SUiTE 200 <br /> Name of contact person Telephone number E-mail address <br /> Jeff Smoke,Director (574 ) 251-4400 JEF jsmoke(d!greatlakescapital.cam <br /> SECTION 2 LOCATION AND DESCRIPTION OF PROPOSED PROJECT <br /> Name of designating body Resolution number <br /> Common Council of City of South Bend <br /> Location of property County DLGF taxing district number <br /> Ignition Park <br /> Description of real property Improvements,redevelopment,or rehabilitation(use additional sheets it necessary) Estimated start date(month,day,year) <br /> November 2019 <br /> Proposed investment of over$16,000,000 for new construction of office building in Ignition Park Estimate <br /> dcompletion date(month,day,year) <br /> Feb.20121 <br /> SECTION 3 ESTIMATE OF EMPLOYEES AND SALARIES AS RESULT OF PROPOSED PROJECT <br /> Current number Salaries Number retained Salaries Number additional Salaries <br /> SECTION 4 ESTIMATED TOTAL COST AND VALUE OF PROPOSED PROJECT <br /> REAL ESTATE IMPROVEMENTS <br /> COST ASSESSED VALUE <br /> Current values I <br /> Plus estimated values of proposed project 16,000.000 <br /> Less values of any property being replaced <br /> Net estimated values upon completion of project 516.000.000 <br /> SECTION 5 WASTE CONVERTED AND OTHER BENEFITS PROMISED BY THE TAXPAYER <br /> Estimated solid waste converted(pounds) Estimated hazardous waste converted(pounds) <br /> Other benefits <br /> SECTION 6 TAXPAYER CERTIFICATION <br /> I hereby certify that the represent(o In i statement are true. <br /> Signature of authorized representativ I Date sig ed( 'th,day.year) <br /> 3/ 1 Ii9 <br /> Printed name of authorized representa'ye C Title <br /> ejtC <br /> Page 1 of 2 <br />