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STATEMENT OF BENEFITS <br />REAL ESTATE IMPROVEMENTS <br />1` Stale Form 51767 IRS 112 -13) <br />Prescribed by the Department of Local Government Finance <br />This statement is being completed for real properly that qualifies under the following Indiana Code (crack one box): <br />© Redevelopment or rehabilitation of real estate improvements (IC 6 -1.1- 12.1 -4) <br />O Residentially distressed area (IC 6- 1.1- 12.14.1) <br />20_ PAY 10_ <br />FORM SB -1 I Real Property <br />PRIVACY NOTICE <br />Any informatbn conoeMrg the cost <br />oftheprops,y andspeeocyyiricsalaries <br />prodppeny caner, 6 conic serial by <br />PC 6-1.1- 12.1 -5.1. <br />INSTRUCTIONS: <br />1. This statement must be submitted to the body designating the Economic Revitalization Area prior to the public heating if me designating body requires <br />information from the applicant in making its decision about whether to designate an Economic RevitalizadionArea. 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 />2. The statement of benefits form must be submitted to the designating body and the area designated an economic revitalization area before the initiation of <br />0e redevelopment or rehabilitation for which the person desires to claim a deduction. <br />3. To obtain a deduction, a Form 322/RE must be filed with the County Auditor before May 101n the yearin which the addition to assessed valuation Is <br />made or not later than thirty (30) days after the assessment notice Is mailed to the property owner if it was mailed afferApril 10. A property owner who <br />/ailed to file a deduction application within the prescribed deadline may file an application between March 1 and May 10 of a subsequenryeer. <br />4. A ptoperty owner who riles for the deduction must provide the County Auditor and designating body with a Form CFI/Real Propedy The Form CF-1 1Ree1 <br />Property should be attached to the Form 3221RE when the deduction is first claimed and then updated annually for each year the deduction is applicable. <br />IC 6 -1.1- 121- 5.1(b) <br />5. For a Form SS -7 /Real Property that is approved after June 30. 2013, the designating body is required to establish an abatement schedule for each <br />deduction allowed. Fora Form SB -1 /Real Property that /s approved prior to July 1, 2013, the abatement schedule approved by the desggnsfing body <br />remains in effect. IC 5.1.1- 12.1 -17 <br />Page 1 of 2 <br />Name of taxpayer <br />Lock Joint Tube LLC <br />Address of taxpayer (numbsrand street, city, state, and ZlPcods) <br />515 West Ireland Road, South Bend, Indiana 46614 <br />j <br />Nanm, ofcontaetpercon <br />Telephonenumber <br />E-manaddmss <br />Robert Strzeleckt;Controller <br />( 574 ) 299 -3455 <br />I <br />stizeleck1balltube,com <br />PiI FA91-5-1 <br />16NE.Imuffiii <br />Nam of dosig mlirg body <br />Resolution number <br />Common Council of City of South Bend _ <br />Location of properly <br />County <br />DLGF Wring dIsIr¢I number <br />515 West Ireland Road; South Bend, Indiana 46614 <br />St. Joseph <br />026 <br />Desorption o rupl prop. lmpovamenls.red"ebpmon4 or rshninamionfuso adr4ttwor wools ra necessary) <br />EstMated start date(mooth, day, year) <br />Proposed investment of between $1.1 and $1.5 million to construct a <br />new building additiontexpansion of <br />04/01/2014 <br />– 30,000 square feet, to be used for manufacturing purposes as well as to facilite the reconfiguration of <br />certain operations within Lock Joint Tube's facility on West Ireland Road. <br />comps <br />Estimated compWlion dale (month, day, year) <br />04101/2015 <br />Current number <br />Salaries Number retained <br />salaries Number additional Salaries <br />• • • <br />• •• • ••• <br />REAL ESTATE I3�23 <br />VEMENTS <br />COST <br />SED VALUE <br />Current values <br />2,302.300+/— <br />00 <br />Plus estimated values of proposed project <br />1,100.000 <br />PO2, <br />Liss values of an roped being replaced <br />N/A <br />Net estima ted values uponcompleltono (project <br />3.402,300+/— <br />Det. Udder Re�. 17 <br />• A zlUfi • • F <br />Estimated solid waste converted (pounds) <br />Estimated hazard6u3 waste- Orivladed (pounds) - <br />O(herbenefls <br />_,- <br />V <br />1. <br />t <br />. CERTIFICATION, <br />I hereby certify that the representations in this statement are true. <br />si "'t eal- oiizod,Pro <br /><stiµ) z9� <br />Date signed(monlh,'dey, year) <br />• 3 �s S <br />3-S -I <br />Printed nom of authorized repres alive <br />Trua <br />Robert Strzelecki <br />Controller <br />Page 1 of 2 <br />