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54 s STATEMENT OF BENEFITS 20_PAY 20_ A `• VACANT BUILDING DEDUCTION 10, Slate Form 55182(R 1 2-14) FORM SB-1 I VBD Prescribed by the Department of Local Government Finance PRIVACY NOTICE This statement is being completed for real property that qualifies as an"eligible vacarl building"as defined by The cost and any specific individual'sIC6-1.1-12.1-1(17). salary information is confidential,the balance of the filing is public record per IC 6-1 1-12.1-5.1(c)and(d). 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 occupation of the eligible vacant building for which the person wishes to claim a deduction. 2. To obtain a vacant building deduction,a Form 322N813 must be filed with the county auditor before May 10 in the year in which the property owner or his tenant occupies the vacant building or not later than thirty(30)days after the assessment notice is mailed to the property owner if it was mailed alerApril 10. if the property owner misses the May 10 deadline in the initial year of occupation,he can apply between March 1 and May 10 of a subsequent year. 3 A property owner who files the Form 322NBD must provide the county auditor and the designating body with a Form CF-1NBD to show compliance with the approved Form SB-1NBD. The Form CF-1NBD must also be updated each year in which the deduction is applicable. SECTION 1 TAXPAYER INFORMATION Name of WSJM- INCaer Address of taxpayer(number and street,city state,and ZIP code) 1301 EasDouglas Road Mishawaka,IN 46545 Name of contacterson Tel hone number E-mad addressDavidDoetsciX269j925-1111 davedtgmidwestfamilyswmi.com SECTION 2 LOCATION AND DESCRIPTION OF PROPOSED PROJECT Name of designating body ho;c.ul or.numcer City of South Bend Location of property County DLGF taxing district number316EastMonroeStreetSt.Joseph Description of eligible vacant building that the property owner or tenant will occupy(use additional sheets 11 necessary). Estimated occupancy date(month,day.year)The building consists of 2 floors with a total square footage of 1 ,185sf.The construction consists of February 22.2021 precast concrete wall panels and a conventional bar joist roof deck with built up roof.Building has Estimated date placed inose(month,day.year)been vacant for over 12 months. SECTION 3 ESTIMATE OF EMPLOYEES AND SALARIES AS A RESULT OF PROPOSED PROJECT Current number Salaries Number retained Salaries Number additional Salaries 23 1,040,520 23 1,040,520 3 105,000 SECTION ESTIMATED TOTAL COST AND VALUE OF PROPOSED PROJECT REAL ESTATE IMPROVEMENTS COST ASSESSED VALUE Current values 235,000 Plus estimated values of proposed project 3,100,600 Less values of any property being replaced Net estimated values upon completion of project 3,335,600 SECTION 5 EFFORTS TO SELL OR LEASE VACANT BUILDING igowngtiren lls[e0 IIre agrs`tacegral teSag:a reAVIVciVreags ate serncees,worldwide company.It was previously a data center owned by CyrusOne. Show amount for which the building was offered for sale.lease,or rent during period of vacancy. The list price was"Negotiable"when the offer to purchase was made. tf'he7xsprigeullcaingw°R Mlome`"`i'r a i{t urge gzpeenceAT8adcasting company.By revitalizing this existing building and bringing new employees to this location,a new sense of confidence should be felt by other businesses looking to relocate to this area of South Bend.This new development should also provide support to existing local amenities or encourage new service businesses to locate here. SECTION 6 TAXPAYER CERTIFICATION I hereby certify that the representations in this statement are true. Sign a of authorized rept alive Title President Date signed impnrA08 yyg$r)t I U4/ LUZU Page 1 of 2