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Filed in Clerk's Office <br />Filed in Clerk's Office i <br />I APR 182023 <br />STATEMENT OF BENEFITS MAR 3 L 2023 <br />At <br />1 REAL ESTATE IMPRovEMENTS <br />taS N111 State Fonns1767(R711-21) DAWN M. JONES <br />ND IN <br />l ND, IN <br />Prescribed by the Department o1 Local Government pinaetLCl y CLERK, SOUTH BE <br />PRIVACY NOTICE <br />This statement is being completed for teal property that qualifies under the folowing Indiana Code (check one box): Any Woffn&Wn con comng ustngtheo <br />D Redevelopment or rehab4itation of real estate Improvements (IC 61.1-12.14) d the p operty and speaft salaries <br />Residentially ds!rossed 8re9 (iC & <br />paid to Indvtdual ampwtoyyeeww by the1.1-12.1 4.1) owrw is cortwnbw per <br />IC <br />INSTRUCTIONS. <br />2. <br />1. <br />1. This statement must be submitted to the body designating the Economic Revitakm6on Area pnor to the public heating i(tho designating body requires <br />information from the applicant in malting its decision about whether to dasignala an Economic Revitalization Area. Otherwise. Itis statement must be <br />submitted to rho designating body BEFORE the redevebpment or rehabititafion of teal property for which the person wishes to claim a doductlon. <br />2. The statement of benards form must be submitted to rhe dasignabng body and the area designated an economic rovifelization area before the lnitieffon of <br />the rudevelopmeM or rehabilitation for which the person desires to claim a deduction <br />3. To obtain a deduction, a Fort 322YRE must be filed with the county auditor before May 10 in the year In which the addidan to assessed valuation is <br />made or not later than thirty (30) days oiler the assessment notice is mailed to the property owner Hit was mailed aRerAprrl 10. A property owner who <br />felled to INe a deduction application within the prescribed doadgrto may rile an application behwen January 1 and May 10 eta subsequent year. <br />4. A property owner who fikis W the deduction must provide the county auditor and designating body with a Form CF-URaal Property The Form CF-I/Real <br />Property should be attached to the Form 3221RE when the deduction is first claimed and than Loafed annually far each year the deduction is appllcab(e. <br />fC 61.1-12.1-5.1(b) <br />5. For a Form SB-ilReal Property that is approved afar June 30. 2013. the designating body is naquired to esfabNsh an abatement schedule for each <br />deduction allowed. For a Fort SB-IlReal Propwly that is approved prior to July 1. 2013, the abatement schedule approved by the designating body <br />remains in effect. IC 61.1-12.1-17 <br />SECTION•• • <br />Name at taxpayer <br />Cross Community Inc. <br />Addm a <br />a f taxpefe r <br />Number•nd.tr L 707 Sherman Ave city South Bend clear IN zip: 46616 <br />Name of contact presort TAMhona number E-mail addrs"a <br />Flnr Name•. Tina tail Name. Patton (574) 876-2106 Imtpanon2®comcesLnet <br />SECTJON 2 LOCATION AND DESCRIPTION OF PROPOSED PROJECT <br />Name of dosigruting body <br />Common Council of the City of South Bend <br />Resoitibon number <br />Locelmw of pn)perty county DLGF UWng district number <br />Numbcraad stn,: 724 Harrison Avenue air. <br />south Bend <br />Sato IN ?,, 46616 St. Joseph 026 (South Bend -Pottage) <br />Deacnplfon of res! property impfo remants. rederetoprnertt, Cc rahebi Rion (use addrdo, JSh@afSffn*CftWryj EAinwed start dots fnwth, dry, year) <br />We will building 2 new homes that in general will be between 1390-1620 sgft. The tomes will 5/1/2023 <br />be sold to first time homeowners who have participated in tinanciaUcredit bullding workshops. Es*,newd oarnpaban date (-000, day. yftr) <br />12/1/2023 <br />REAL ESTATE IMPROVEMENTS <br />COST ASSESSED VALUE <br />Current values $2.600 <br />Plus ostimated values of proposed project $220.000 S 242.400 <br />Less values of any property tieing replaced <br />Not estimated values upon completion of Proiact $ 220,000 3 246,000 <br />Estimated solid waste converted (pounds) Estimated hazardous waste converted (pounds) <br />Other benefits <br />The homes will be sold to first time homeowners who have participated in financial/credit <br />building workshops. <br />SECTION 6 TAXPAYER CERTIFICATION <br />I hereby certify that the representations in this statement are true. <br />signature tit outto,tred represenfaftya „/f Data signed Pow1h. day, year) <br />tL/ ,fj&7C_,,, 13/3012023 <br />PAntedname ofauthorindropmsertmrb'" <br />Tina M. Patton TitoPresident <br />Page 1 of 2