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COMPLIANCE WITH STATEMENT OF BENEFITS <br />REAL ESTATE IMPROVEMENTS <br />State Form 51766 (R312 -13) <br />S , „ ✓ Prescribed by the Department of Local Government Finance <br />INSTRUCTIONS. <br />I. This form does not apply to property located in a residentially distressed area or any deduction for which the <br />Statement of Benefits was approved before July 1, 1991. <br />2. Property owners must rile this form with the county auditor and the designating body for their review regarding <br />the compliance of the project with the Statement of Benefits (Form SB -1 /Real Property). <br />3. This form must accompany the initial deduction application (Form 32ZRE) that is riled with the county auditor. <br />4. This form must also be updated each year in which the deduction is applicable. It is filed with the county auditor <br />and the designating body before May 15, or by the due date of the real property owner's personal property return <br />that is filed in the township where the property is located. (IC 6- 1.142.1- 5.1(b)) <br />5. With the approval of the designating body, compliance information for multiple projects maybe consolidated on <br />one (1) compliance form (Form CF -1 /Real Property). <br />29 13 PAY 20.14 <br />FORM CF -1 / Real Property <br />PRIVACY NOTICE <br />The cost and any specific Individual's <br />salary Information is confidential; the <br />balance of the filing is public record <br />per IC 6-1.1- 12.15.1 (c) and (d). <br />SECTION <br />•. <br />Name of taxpayer <br />County <br />Ameriplex Superior Partners f /k/a Ontario Partners LP <br />St. Joseph <br />Address of taxpayer (number and street, city, state, and ZIP code) <br />DLGF taxing district number <br />227 S. Main St. Suite 300, South Bend, IN 46601 <br />009 <br />Name of contact person <br />Telephone number <br />Timothy A. Baker <br />( 574 ) 2174478 <br />SECTION 2 LOCATION AND DESCRIPTION <br />OF PROPERTY <br />Name of designating body <br />Resolution number <br />Estimated start date (month, day, year) <br />City of South Bend <br />4238 -13 <br />9/1/2012 <br />Location of property <br />Actual start date (month, day, year) <br />5231 Dylan Drive, South Bend, IN 46628 <br />9/2012 <br />Description of real property improvements <br />Estimated completion date (month, day, year) <br />New 105,000 Sq. Ft. Industrial Building <br />7/1/2013 <br />Actual compl.b.n data (month, day, year) <br />6/30/2013 <br />SECTION 3 EMPLOYEES AND <br />SALARIES <br />EMPLOYEES AND SALARIES <br />AS ESTIMATED ON SB -1 ACTUAL <br />Current number of employees <br />Salaries <br />Number of employees retained <br />Salaries <br />Number of additional employees <br />62 Building not <br />Salaries <br />2,100,000 complete <br />SECTION 4 COST AND <br />VALUES <br />COSTAND VALUES <br />REAL ESTATE IMPROVEMENTS - <br />AS ESTIMATED ON SO-1 <br />COST <br />ASSESSED VALUE <br />Values before project <br />0 <br />14,700 <br />Plus: Values of proposed project <br />3,500,000 <br />Less: Values of any property being replaced <br />0 <br />Net values upon completion of project <br />3,500,000 <br />ACTUAL <br />COST <br />ASSESSED VALUE <br />Values before project <br />0 <br />Plus: Values of proposed project <br />3,090,683 <br />Less: Values of any property being replaced <br />0 <br />Net values upon completion of project <br />- <br />3,090,683 <br />3,347,100 <br />• • .. • • • <br />•• <br />WASTE CONVERTED AND OTHER BENEFITS <br />AS ESTIMATED ON SB -1 ACTUAL - <br />Amount of solid waste converted <br />N/A N/A <br />Amount of hazardous waste converted <br />N/A N/A <br />Other benefits: <br />SECTION 6 <br />I <br />N/A N/A <br />TAXPAYER CERTIFICATION <br />hereby certify that the representations in this statement are true. <br />SignaturALV authoriz represaetativa/ <br />'',1If <br />Title <br />Date signed (month, day, year) <br />VP & Partner <br />April 28, 2014 <br />Page 1 of 2 <br />