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" _ STATEMENT OF BENEFITS <br />j REAL ESTATE IMPROVEMENTS 20 PAY 20_ <br />tr State Form 51767 (R3112 -11) <br />FORM SB -1 /Real Property <br />Wa� Prescribed by the Department of Local Government Finance <br />This statement is being completed for real property that qualifies under the following Indiana Code (check one box): <br />m Redevelopment or rehabilitation of real estate improvements (IC 6-1.1- 12.1 -4) <br />❑ Eligible vacant building (IC 6-1.1- 12.1 -4.8) <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 ERA/RE 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, if any, or the county assessor. <br />4. Property owners whose Statement of Benefits was approved after June 30, 1991, must attach a Form CF- IlReal 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 <br />5. The schedules established under IC 6 -1.1- 12.1 -4(d) for rehabilitated property and under IC 6 -1.1 -121- 4.8(1) for vacant buildings apply to any statement <br />of benefits approved on orafter July 1, 2000, unless an alternative deduction schedule is adopted by the designating body (IC 6- 1.1- 121 -17). The <br />schedules effective prior to July 1, 2000, shall continue to apply to a statement of benefits filed before July 1, 2000. <br />Name of taxpayer <br />TAMPICO DEVELOPMENTS, LLC <br />Address of taxpayer (number and street, city, stab, and ZIP code) <br />737 RIVER POINTE PLACE, MISHAWAKA, IN 46544 <br />Name of contact person <br />CITY OF SOUTH BEND COMMON COUNCIL <br />ation of property <br />5405 ROYAL STREET <br />scnption of real property improvements, redevelopment, or rehabilitation (use <br />LOT 3 OF CRESCENT OAKS, SECTION 1A <br />SECTION OF <br />Current number Salaries Number retained <br />N/A N/A I N/A <br />NOTE: Pursuant to IC 6 -1.1- 12.1 -5.1 (d) (2) the COST of the property <br />is confidential. <br />Current values <br />Plus estimated values of proposed project <br />Less values of any provertv beino replaced <br />Net estimated values upon completion of <br />Estimated solid waste converted (pounds) N/A <br />Other benefits <br />N/A <br />I hereby c*'Ify that the representations in this statement are true. <br />Signature of ut rized repr9jentatiiv �/7 <br />Telephone number E-mail address <br />(574) 255 -1503 Ac..f;. A 0A <br />Resolution number <br />3862 -08 <br />County DLGF taxing district number <br />ST. JOSEPH nAa <br />Estimated stair date (month, day, year) <br />2013 <br />Estimated completion date (month, day, year) <br />+/- 1 YEAR <br />Salaries Number additional <br />N/A I N/A <br />REAL ESTATE IMPROVEMENTS <br />COST I ASSESSED VALUE <br />N/A <br />Estimated hazardous waste n- oawrted (Bounds) - N/A <br />V4 P, ftl �Tetrpflj'- <br />Ct'rf �Olr e °aIµftrET 6f t <br />Title Date signed (month, day, year) <br />SOLE MEMBER <br />Page 1 of 2 <br />