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•' STATEMENT OF BENITS ` <br /> '1:' REAL ESTATED <br /> IMPROVEMENTS <br /> Stale Form 51767(R6 r 10-11) <br /> FORM SO-61 I Real Property <br /> Prescribed by the Department of Local Government Finance zoPAY zo <br /> PRIVACY NOTICE <br /> This statement is being completed for real property that q uallfies under the following Indiana Code(check one boy): Any information concerning the cost <br /> o Redevelopment or rehabilitation of real estate improvements(IC 6-1.1-12.1-4) of the property and specific salaries <br /> • <br /> ❑Residential) distressed area(IC 6-1.1-12.1-4.1 prop to ownerindividual employees by the <br /> Y ) pprroop i 1 - is confidential per <br /> INSTRUCTIONS: IC&t t t2.t•5.t <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 alter 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 CountyAuditor 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(6) <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 /> i <br /> SECTION 1 TAXPAYER INFORMATION <br /> Name of taxpayer <br /> WSJM-INC <br /> Address of taxpayer(number and street,city slate,and ZIP code) <br /> 1301 East Douglas Road, Mishawaka, IN 46545 <br /> Name of contact person Telephone number E-mail address <br /> Dave Doetsch ( ) 269-925-1111ved@midwestfamilyswmi.com <br /> SECTION 2 LOCATION AND DESCRIPTION OF PROPOSED PROJECT <br /> Name of designating body Resolution number <br /> City of South Bend, IN <br /> Location of property County DLGF taxing district number <br /> 316 East Monroe Street St. Joseph <br /> Description of real property Improvements,redevelopment or rehabilitation(use additional sheets If necessary) Estimated start date(month,day,year) <br /> July 1,2020 <br /> The 18,185sf building was built in 1985. It is a vacant 2 story building. It will re renovated to Estimated completion date(month,day year) <br /> February 26,2021 <br /> SECTION 3 ESTIMATE OF EMPLOYEES AND SALARIES AS RESULT OF PROPOSED PROJECT <br /> Current number Salaries Number retained Salaries Number additional Salaries <br /> 23 $1,028,560 23 $1,028,560 3 <br /> SECTION 4 ESTIMATED TOTAL COST AND VALUE OF PROPOSED PROJECT <br /> REAL ESTATE IMPROVEMENTS <br /> COST ASSESSED VALUE , <br /> Current values 15235,000 <br /> Plus estimated values of proposed project 1$3,100,600 <br /> Less values of any property being replaced 1° <br /> Net estimated values ••n c• •ietion of•oject <br /> SECTION 5 WASTE CONVERTED AND OTHER BENEFITS PROMISED BY THE TAXPAYER <br /> n/a <br /> Estimated solid waste converted(pounds) Estimated hazardous waste converted(pounds) <br /> Other benefits .• <br /> • <br /> SECTION 6 TAXPAYER CERTIFICATION , <br /> I hereby certify that the representations in this statement are true. <br /> Signature of authorized pre ntative Date signed(month,day,year) <br /> �f I4/8/20 <br /> Prin me of authorized repr n ave ripe I <br /> Dave Doetsch President <br /> Page 1 of 2 <br />