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STATEMENT OF BENEFITS <br />REAL ESTATE IMPROVEMENTS <br />t�t State Form 51767 (R2 / 1 -07) <br />` Prescribed by the Department of Local Govemment Finance <br />This statement is being completed for real property that qualifies under the following Indiana Code (check one box): <br />0 Redevelopment or rehabilitation of real estate improvements (IC 6- 1.1- 12.1 -4) <br />❑ Eligible vacant building (IC 6-1.1- 12.14.8) <br />20 08 PAY 20 09 <br />FORM SB -1 I Real Property <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 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 />"Projects" planned or committed to after July 1, 1987, and areas designated after July 1, 1987, require a STATEMENT OF BENEFITS. (IC 6 -1.1 -12.1) <br />2. Approval of the designating body (City Council, Town Board, County Council, etc.) must be obtained prior to initiation of the redevelopment or rehabilitation,, <br />BEFORE a deduction may be approved. <br />3. To obtain a deduction, application Form 322 ERAIRE or Form 322 ERA/VBD, Whichever is applicable, must be tiled with the County Auditor by the later <br />of.• (1) May 10; or (2) thirty (30) days after the notice of addition to assessed valuation or new assessment is mailed to the property owner at the address <br />shown on the records of the township assessor. <br />4. Property owners whose Statement of Benefits was approved after June 30, 1991, must attach a Form CF- 1/Real Property annually to the application to <br />show compliance with the Statement of Benefits. (IC 6- 1.1- 12.1- 5.1(b) and IC 6 -1.1- 12.1 - 5.30)] <br />5. The schedules established under IC 6-1.1- 12.1 -4(d) for rehabilitated property and under IC 6-1.1- 12.1 - 4.8(1) for vacant buildings apply to any statement <br />of benefits approved on or after July 1, 2000. The schedules effective prior to July 1, 2000, shall continue to apply to a statement of benefits filed before <br />July 1, 2000. <br />SECTION •- • <br />Name of taxpayer <br />Habitat for Humanity of St. Joseph County <br />Address of taxpayer (number and street, city, state, and ZIP code) <br />402 E. South Street, South Bend, IN 46601 <br />Name of contact person Telephone number <br />E -mail address <br />David Hatch (574) 288 -6967 <br />SECTION 2 LOCATION AND DESCRIPTION OF PROPOSED PROJECT <br />Name of designating body <br />Resolution number <br />City of South Bend Common Council <br />Location of property <br />nty <br />DLGF taxing district number <br />701 S. Grant Street & 601 Cottage Grove Avenue 711t. <br />Joseph <br />18/Portage <br />Description of real property improvements, redevelopment or rehabilitation (use additional sheets if necessary) <br />Estimated start date (month, day, year) <br />New single family residences, 1120 -1360 square feet, 3 bedrooms, 1 bath, 4 foot crawl <br />06 /01/2008 <br />Estimated completion date (month, day, year) <br />space or basement <br />12/01/2008 <br />SECTION OF •••. PROJECT <br />Current number Salaries Number retained Salaries Number additional Salaries <br />SECTION 4 ESTIMATED TOTAL COST AND VALUE OF PROPOSED PROJECT <br />I <br />NOTE: Pursuant to IC 6-1.1- 12.1 -5.1 (d) (2) the COST of the property REAL ESTATE IMPROVEMENTS <br />is confidential. COST ASSESSED VALUE <br />Current values <br />0.00 <br />7.400.00 <br />Plus estimated values of proposed project <br />146.000.00 <br />170.000.00 <br />Less values of any property being replaced <br />0.00 <br />0.00 <br />Net estimated values upon completion of project <br />146.000.00 <br />177.400.00 <br />SECTION • . AND OTHER BENEFITS PROMISED <br />Estimated solid waste converted (pounds) Estimated hazardous waste converted (pounds)__ <br />Other benefits F } r' _ • =j'° <br />Aff, <br />CERTIFICATION TAXPAYER SECTION 6 <br />1 her ce Vhat the rep sentations in this statement are true. <br />Sig lure of authoriAh r sen i <br />Title <br />Dater. ne (month ay, year <br />Executive Director <br />Z 0 <br />Page 1 of 2 <br />