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off STATEMENT OF BENEFITS 20 PAY 20 <br />s VACANT BUILDING DEDUCTION <br />Stale Form 55182(R!2- 14) FORM SB-1 i VBDti- <br />4„5Y Prescribed by the Department of Local Government Finance <br />PRIVACY NOTICEThisstatementisbeingcompletedforrealpropertythatqualifiesasan"eligible vacant building"as defined by The cost and anIC6-1.1-12.1- 1(17). <br />confidential, <br />individual's <br />salary informationn iss cononfidential,the <br />balance of the fling is public record <br />per IC 6-1 1-12.1-5.1(c)and(d). <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 bodyrequiresinformationfromtheapplicantinmakingitsdecision about whether to designate en Economic Revitalization Area. Otherwise, this statement <br />must be submitted to the designating body BEFORE the occupation of the eligible vacant building for which the person wishes to claim a deduction. <br />2. To obtain a vacant building deduction,a Form 322N1313 must be filed with the county auditor before May 10 in the year in which the property owner <br />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 <br />mailed after April 10. If the property owner misses the May 10 deadline In the initial year of occupation,he can apply between March 1 and May 10ofasubsequentyear. <br />3 A property owner who tiles the Form 322N8D must provide the county auditor and the designating body with a Form CF-1NBD to show compliance <br />with the approved Form SB-1NBD. The Form CF-INBO must also be updated each year in which the deduction is applicable. <br />SECTION 1 TAXPAYER INF t RMA7ION <br />WSJtalxpayer <br />Address of taxpayer(number and street,city,state,and ZiP code) <br />1301 East Douglas Road Mishawaka,IN 46545 <br />Name of contact person Tele hong number E-mail addressDavidDoetschX269925-1111 daved@midwestfamilyswmi.com <br />SECTION 2 LOCATION AND DESCRIPTION F PROPOSED PROJECT <br />Name of designating body Resolution numberCityofSouthBend <br />Location of property County DLGF taxing district number316East Monroe Street St.Joseph <br />Description of eligible vacant building that the property owner or tenant will occupy(use additional sheets"'necessary). Estimated occupancy dale(month,day.year)The building consists of 2 floors with a total square footage of 18,185 sf The construction consists of February 22.2021 <br />precast concrete wall panels and a conventional bar joist roof deck with built up roof.Building has <br />been vacant for over 12 months. Estimated date placed-in-use( month, day.year) <br />SECTION 3 ESTIMATE OF EMPLOYEES AND SALARIES AS A RESULT OF PROPOSED PROJECT <br />Current number Salaries Number retained Salaries Number additional Salaries231,040,520 23 1,040,520 3 105,000 <br />SECTION ESTIMATED TOTAL COST AND VALUE OF PROPOSED PROJECT <br />REAL ESTATE IMPROVEMENTS <br />COST ASSESSED VALUE <br />Current values 235,000 <br />Plus estimated values of proposed project 3,100,600 <br />Less values of any property being replaced <br />Net estimated values upon completion of project 3,335,600 <br />SECTION 5 EFFORTS TO SELL OR LEASE VACANT BUILDING <br />scribed efforts h ner or r vtous ow r s lease or rent the buildi our orf of v ndieowneretiiiecdml"ie assistance oreNAI Messy;a commerclarlgreai`esta`te eaniTe`ys,worldwide company.It was previously a data center <br />owned by CyrusOne. <br />Show amount for which the building was offered for sale. lease,or rent during period of vacancy. <br />The list price was"Negotiable"when the offer to purchase was made. <br />Foie existing r'uttaig(win oe name to`a1°mattur¢e texpenencelioroadcasting company By revitalizing this existing building and bringing new <br />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 <br />new development should also provide support to existing local amenities or encourage new service businesses to locate here. <br />SECTION 6 TAXPAYER CERTI (CATION <br />I hereby certify that the representations in this statement are true. <br />Sign a of authorized rept alive <br />I Title Date signed(month da, r) <br />President I04)08)2d20 <br />Page 1 of 2