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STATEMENT OF BENEFITS <br /> 4 j REAL ESTATE IMPROVEMENTS so�PAY 20� <br /> `•, State Form 51787(83112-11) FORA9 51911 1 Real Property <br /> 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 /> ® Redevelopment or rehabilitation of real estate improvements(IC 6-1.1-12.1-4) <br /> ❑ Eligible vacant building(IC 6-1.1-12.1-Cli) <br /> INSTRUCTIONS: <br /> I- 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 staiement muss be <br /> submitted to the designating body BEFORE the redevelopment or rehabilitation of real property for which the person wishes fQ 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_ f1C 6-1.1-12.i) <br /> 2 oFthe ( vedauncll, Town Boaro County Council etc_)most be obtained prarto nGtn BEFORE o deduction maybe rro of the redevelopment or rehabilitation, <br /> 3, To obtain a deduction,application Form 322 ERA/RE or Form 322 ERAIVED, Whichever Is applicable,must be filed 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 <br /> shown on the records of the township assessor,if any,or the county assessor. is mailed to the property owner at the address <br /> 4. Property owners whose Statement of Benefds was approved after June 30, 1991,must attach a Form CF-1/peal property,annually to the appiicatiorr to <br /> show compliance with the Statement of Benefits. (lC 6-1.1-12.1-5.1(b)and IC 6-1.1-12.1-5.31.7)] <br /> 5. The schedules established under IC 6-1.I-1Z 1-4(d)for rehabilitated property and under IC 6-1,1-12.1-4.8(1)for vacant buildings appl y to an <br /> of benefits approved on or after July 1,2000,unless an altemative deduction schedule Is adopted by the designating body 1lC 6-7.1-12.1-a y statement <br /> schedules effectfve prior to July <br /> iiiji i111110 IN M11 111111 <br /> 1,2000,shall continue to apply to a statement ofbenefrts Sled before July f,2000. <br /> • <br /> Name of taxpayer <br /> TAMPICO DEVELOPMENTS, LLC <br /> Address of taxpayer(numberand street,city,state,and Zip rode) <br /> 737 RIVER POINTE PLACE, MISHAWAKA, IN 46544 <br /> Name of contact person Telephone number <br /> DENNIS SCHWARTZ E-Mail address <br /> 574)255-1503 dschW194D aol.com <br /> • ® ® e r e •-•-• d •°• <br /> Name of designating body <br /> CITY OF SOUTH BEND COMMON COUNCIL Resolution number <br /> Location of property County 3862-08 ST. JOSEPH <br /> 5405 ROYAL STREET DLGF taxing district number Description of real property improvements,redevelopment,or rehabilitation(use additional sheets ifnecessary) 033 <br /> year) <br /> Estimated start date(month,day, <br /> LOT 3 OF CRESCENT OAKS, SECTION 1A 2013 <br /> Estimated completion date(month,day,year) <br /> e {/- 1 YEAR <br /> Current number Salaries Number retained Salaries <br /> N/A N/A N/A Number additonal <br /> Salaries <br /> N/'`, N/A N/A <br /> • i ' • s • '•-• a •-e <br /> NOTE:Pursuant to IC 8-1.1-121-5.1 (d)(2)the COST of the property REAL ESTATE IMPROVEMENTS <br /> is confidential. COST ASSESSED VALUE <br /> values 30 0000 <br /> .0 <br /> Plus estimated values of proposed project 155 00 0 50©.00 <br /> Less values of any property being replaced N/A <br /> Net estimated values upon completion of project 185,000.00 <br /> c e e e • -• e _ <br /> Estimated solid waste converted(pounds) N/A Estimated hazerdqu waste rted ounds N/A <br /> other benefits <br /> Q1 ..# <br /> r <br /> I hereby ce ify that the representations in this statement are true. <br /> Signature of ut rized repr entativ Title Date signed(month,da <br /> SOLE MEMBER day <br /> Page 1 of 2 <br />