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Filen in <br /> -',",. STATEMENT OF BENEFITS k4erk'S <br /> ems; t,I. REAL ESTATE IMPROVEMENTSFORM SB1/Rea!Property <br /> e LT7`• 70?3 I PRIVACY NOTICE <br /> ,Is statement is being-completed for .. oat qualifies un: ;fa Ind; ,yco iiderif ono.bo;l Any nformation concerting the-cost <br /> Redevelopment or rehabilitation or eaa' m <br /> oveent,.IC z.. • C "Y or the.property and specific salaries <br /> ..J Residentially distressed area(IC 6-1.1-12.1-4 ,) �ER !yx S, • <br /> JONES' paid to ndividual employees ay the <br /> QU p property owner:s confidential pet <br /> p IC 6-1 1-12,1-5 1. <br /> INSTRUCTIONS -N�,SPI <br /> I This statement must be submitted to the body designat;ng the Economic Revitalization Area prior to the public h if the designating body requires <br /> information from the applicant in making Is decision about whether to designate an Economic Revitalization Area Otherwise this statement must be <br /> submitted to the designating body BEFORE the-edevelopment or rehabddatioe 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 rev/falization area before the initiation o; <br /> the redevelopment or rehabilitation for which the person desires to claim a deduction <br /> 3 To obtain a deduction,a Form 322•PE must be filed with,tie count;r auditor before May 10 in the year in which the addition to assessed vaivanon 15 <br /> made or not later than thirty(30)days after the assessment nonce is mailed to the property owner if It was mailed after'lent 10 A arocemy owner who <br /> failed lc file a deduction application within the prescribed deadline may file an application between January 1 and May 10 of a subsequent year <br /> 4 4 property owner who files for the deduction must provide the county auditor and designating body with a Form CF-1:Real Properly The Form CF-1/Real <br /> Property should be attached to the Fotrn 322'RE when the deduction is first claimed and then updated annually for each year the deduction.s aopiicabie <br /> IC 5-1 1-12 1-5 1(b) <br /> 5 For a Form SG-1/Real Property that;s 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 5-1 1-12.1-17 <br /> SECTION 1 . TAXPAYER INFORMATION' <br /> Name of taxpaye <br /> Five Corners LLC <br /> Address of taxpayer <br /> .umncr vnx;uyct: 814 Marietta Street cin- South Bend ;fair: IN nn. 46601 <br /> (Name of contact persor Telephone number E-mail address <br /> Firsr\A,ii Anne Lim Name. Hayes (574) 210-5167 ahayes@telcompark.com <br /> SECTION 2 LOCATION AND DESCRIPTION OF PROPOSED PROJECT <br /> Name of designating body <br /> Resolution number <br /> Common Council of the City of South Bend <br /> Location of prooeCy County DLGF taxing district number <br /> `,,,,,r,,,,,1 4 144 Corby Boulevard .,,,. Sours Bend ,` IN ,tt, 46617 St. Joseph 026(South Bend-Portage) <br /> Description of real property improvements redevelopment_or rehabilitation ivse additional sheets,t"ecessar'jl Estimated start date;.month,day.rear) <br /> Redevelopment of vacant land into two buildings featuring 108 rental 9/13/2023 <br /> Estimated impletion crate;month,day.yeah <br /> apartment units and retail space <br /> 8/31/2025 <br /> SECTION 3 ESTIMATE OF EMPLOYEES AND SALARIES AS RESULT OF PROPOSED PROJECT <br /> Current Number Salaries .Aber Retained SalariesNumber Additional i Salaries <br /> 0 $ 0 0 $ 0 9 s 570,600 <br /> • <br /> SECTION 4 ESTIMATED TOTAL-COST AND VALUE OF PROPOSED PROJECT <br /> REAL ESTATE IMPROVEMENTS <br /> COST ASSESSED VALUE <br /> Current values S 0 $216.200 <br /> Plus estimated values of proposed project $24.500 000 - . S 19.600.000 <br /> Less values of any property being replaced S 0 326.200 <br /> 1 1 <br /> Net estimated values upon completion of project 3 24.500.000 $19.600,000 <br /> SECTION 5 WASTE CONVERTED AND OTHER BENEFITS PROMISED BY THE TAXPAYER <br /> ' Estimated solid waste converted(pounds) Estimated hazardous waste ;urverieu 4:,-,rids) 0 <br /> Ii Diner enetits <br /> 1 The project is being developed to meet the National Green Building Standard for sustainability <br /> and energy efficiency. <br /> 1 <br /> SECTION 6 TAXPAYER CERTIFICATION <br /> I hereby certify that the representations in this statement are true. <br /> Signature of aumonzed epresentative W'�'�3 (� ' I Date signed;month.day.year) <br /> I 16/30/2023 <br /> ) <br /> Printed name of authorized reoresentative Title <br /> Anne Hayes Member <br /> 'age 1 of 2 <br />