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

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Filed in Clerk's Office 4e._ STATEMENT OF BENEFITS 2020 PAY 2021 ii- i) REAL ESTATE IMPROVEMENTS APR T 202 , / State Form 51767(R6/10-14) PORM SB-1/Real Property '`° Prescribed by the Department of Local Government Finance PRIVACY NOTICE This statement is being completed for real property that qualifies under the following Indiana Code(c 6 90;JON E y'nformatAn concerning the cost Redevelopment rehabilitation of real estate improvements(IC 6-1.1-12.1-4) of the properly and specific salaries p P ✓ic ual employees by the 0 Residentially distressed area(IC 6-1.1-12.1-4.1) CITY CLERK,SOUTH B naris confidential per C 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 322/RE 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-1/Real Property. The Form CF-1/Real 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. 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 Five Corners LLC 1Address of taxpayer(number and street,city,stale,and ZIP code) 814 Marietta St South Bend, IN 46601 Name of contact person Telephone number E-mail address 6 4 (,t e( ( ) 574-233-1296 MMiller@Telecompark.com SECTION 2 LOCATION AND DESCRIPTION OF PROPOSED PROJECT Name of designating body Resolution number Five Corners LLC Location of property County DLGF taxing district number 1132 S Bend Ave South Bend, IN 46617 St. Joseph Description of real property improvements,redevelopment,or rehabilitation(use additional sheets if necessary) Estimated start date(month,day,year) 11/1/2019 Construction and development of a 28,000 SF new mixed use building. Estimated completion date(month,day,year) 5/1/2020 SECTION 3 ESTIMATE OF EMPLOYEES AND SALARIES AS RESULT OF PROPOSED PROJECT Current number Salaries Number retained Salaries Number additional Salaries 0 0 0 0 87 (Indirect) Avg. $65,000 SECTION 4 ESTIMATED TOTAL COST AND VALUE OF PROPOSED PROJECT REAL ESTATE IMPROVEMENTS I COST I ASSESSED VALUE l I Current values I 149,100 Plus estimated values of proposed project 14,315,000 1 Less values of any property being replaced Net estimated values u.on corn.letton of.ro•ect 4 315 000 SECTION 5 WASTE CONVERTED AND OTHER BENEFITS PROMISED BY THE TAXPAYER Estimated solid waste converted(pounds) Estimated hazardous waste converted(pounds) Other benefits i SECTION 6 TAXPAYER CERTIFICATION I hereby certify that the representations in this statement are true. Signature of authorized representative Date signed(month,day,year) ani (Ale,� 09/05/2019 Printed name of authoriresentativeTitle Anne Hayes Member • Page 1 of 2