4811-19 Confirming Real Property Tax Abatement for Five Corners, LLC

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Filed in Clerk'S ,p.1 Office `` APPLICATION FOR DEDUCTION FROM ASSESSED VALUATI t N y 20 24, • f, OF STRUCTURES IN ECONOMIC REVITALIZATION AREAS(E• ) APR �r� State Form 18379(R14/6-16) FORM Prescribed by the Department of Local Government Finance DAWNMJO'NES INSTRUCTIONS: CITY CLERK,SOUTH BEND,IN 1. This form is to be filed in person or by mail with the County Auditor of the county in which the property is located. 2. To obtain this 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(or new assessment)is made,or not later than thirty(30)days after the assessment notice is mailed to the property owner if it was mailed alter April 10.If the property owner misses the May 10 deadline in the initial year of assessment,he can apply between January 1 and May 10 of a subsequent year for the remainder of the abatement term.(Sea also IC 6-1.1-12.1-11.3 concerning the failure to file a timely application.) 3. A copy of the Form 11,the approved Form SB-1/Real Property,the resolution adopted by the designating body,and the Form CF-i/Real Property must be attached to this application. 4. The Form CF-1/Real Property must be updated annually and provided to the County Auditor and the designating body 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,II and Ill below. 7. If property located in an economic revitalization area is also located in an allocation area as defined in IC 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)). 8. Except for deductions related to redevelopment or rehabilitation of real property in a county containing a consolidated city,a deduction for the redevelopment or rehabilitation of real property may not be approved for the following facilities(iC 6-1.1-12.1-3): a. Private or commercial golf course j. Any facility,the primary purpose of which is(a)retail food and beverage b. Country club service;(b)automobile sales or service;or(c)other retail;(unless the c. Massage parlor facility is located in an economic development-target area established d. Tennis club under IC 6-1.1-12.1-7). k. Residential,unless the facility is a multi-family facility that contains at e. Skating facility,including roller skating,skateboarding or ice skating least 20%of the units available for use by low and moderate income f. Racquet sport facility(including handball or racquet ball court) individuals,or unless the facility is located in an economic development g. Hot tub facility target area established under IC 6-1.1-12.1-7,or the area is designated h. Suntan facility as a residentially distressed area which is required to meet conditions as cited in IC 6-1.1-12.1-2(c)(1&2). i. Racetrack I. Package liquor store jsee IC 6-1.1-12.1-3(e)(12)J SECTIO►J,IESCRIRION OF PRPERTY , 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 23 . County Township DLGF taxing district number Key number St.Jospeh Portage 018-5094-3318 Name of owner Legal description from Form 11 Five Corners LLC Lot 1 Corby Blvd and SB Ave Minor Sub Property address(number and street,city,state,and ZIP code) Date of Form 11(month,day,year) 1130 E. South Bend Ave. South Bend, IN 46617 not yet received Type of structure Use of structure mixed use mixed use Governing body that approved ERA designation Date ERA designation approved(month,day,year) Resolution number Common Council 10/28/2019 4811-19 SECTION II-VERIFICATION OF OWNER OR REPRESENTATIVE Signature of owner or representative(t hereby certify that the representations on this application are true.) Date signed(month,day,year) CC h ixe4/13/2023 Printed name of owner or represents ve Address(number and street,city,state,and ZIP code) Anne Hayes 814 Marietta St.South Bend, IN 46601 SECTION III-STRUCTURES AUDITOR'S USE A.Rehabilitation structure 1.Assessed valuation AFTER rehabilitation $ 2.Assessed valuation BEFORE rehabilitation $ 3.Difference in assessed valuation(Line 1 minus Line 2) $ 4.Assessed valuation eligible for deduction $ (for the increase in A/V from the rehabilitation,not including the increase In AN from the reassessment of the entire structure) H B.New structure 1.Assessed valuation $ HrnV2 not yt-/- re u I V. c{ 2.Assessed valuation eligible for deduction $ f m I I, 1 SECTION IV-VERIFICATION OF ASSESSING OFFICIAL 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 1 of 2