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Filed in Cleric's 0f iC-; -- <br />STATEMENT OF BENEFITS <br />REAL ESTATE IMPROVEMENTS JUN j 2 N14 <br />Stale Form 61767 (R412.13) <br />Prescribed by the Department of Local Govemm nt Fine ce <br />This statement is being completed for real property' <br />❑ Redevelopment or rehabilitation of real estate irn <br />❑ Residentially distressed area (IC 6- 1.1- 12.14.1) <br />INSTRUCTIONS: <br />1. This statement must be submitted to the body designating the Economic Revitalization Area prior to the public heating tithe 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 orrehablliation ofteal property for which the person wishes to claim a deduction. <br />"Projects° planned or wmmlfted to ofterJu)y 1, ig87, and areas designated after July 1, 1987, require a STATEMENT OF BENEFITS. (!C 6-1.1 -12.1) <br />2. Approval of the designating body (City Council, Town Board, County Council, etc.) must be obtained pdorto Initiation of the mdevelopment or <br />rehabilitation, BEFORE a deduction may be approved. <br />3. To obtain a deduction, a Form 3221RE must be filed with the CountyAuddor before May 101n the year in which the addition to assessed valuation is <br />made or not later than thirty (30) days afterthe assessment notice is mailed to the property owner if it was mailed afterApol 10. If the property owner <br />misses the May 10 deadline in the initial yearofoccupation, he can apply between March i and May 10 of a subsequent year. <br />4. Property owners whose Statement of Benefits was approved after June 30, 1991, must attach a Form CF- ]/Real 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 6.1.1- 12.1- 5.3(j)j. <br />5. The schedules established under IC 6 -1.1- 12.1 -4(d) formhabilitated property apply to any economic revita!ization areas designated after June 30, 2000, <br />unless an alternative deduction schedule is adopted by the designating body (IC 6-1.1- 12.1 -17). The schedules effective. priorto July 1, 2000, shall <br />continue to apply to economic revitalization areas designated before July 1, 2000. <br />SECTION O <br />Name of taxpayer <br />JJ White, Incorporated <br />Address or taxpayer (number andstreet. city. state, and ZIP code) <br />5500 Bingham Street, Philadelphia, PA 19120 <br />Name of contact person Telephone number E <br />E -mail address <br />Tony Bogard (574 ) 307 -7310 t <br />tbogardQvraeinc.com <br />SECTION • • I DESCRIPTION OF •••• I PROJECT <br />Name of designating may R <br />Resolution number <br />Location of property C <br />County D <br />DLGF taxing district number <br />1904 N. Kenmore St, South Bend, IN 46628 S <br />St. Joseph <br />Description or real property improvements. redevelopment, or rehabilitation (use addi(ionalsheers irnecessary) E <br />Estimated start date (month. day, yeao <br />Purchase and improvements to 1904 N. Kenmore St, South Bend, IN 46628 to accommodate JJ white, Inc.'s Midwest Operations. Improvements 8 <br />811114 <br />include minor once buildout as we as new painting throughout interior and exterior of building. new monument sign, new site fence. and parking lot <br />Estimated completion date (month, day, year) <br />improvements. E <br />9rKY14 <br />SECTION 3 ESTIMATE OF EMPLOYEESAND SALARIES AS RESULT OF PROPOSED PROJECT <br />Current number Salaries Number relaine0 Salaries Number additional Salaries <br />110f6ce /60 Field 17,7000Poce /62,00 Field /Wk 60Fce 142 Fieltl 8,5000Fce/43.680 Fieltl /wk <br />SECT[ON 4 ESTIMATED TOTAL COSTANDVALUE OF ••• I PROJECT <br />REAL ESTATE IMPROVEMENTS <br />COST ASSESSED VALUE <br />Current values - 6 <br />625,000 <br />Plus estimated values of proposed project 1 <br />100.000 <br />Less values of any property beIn2 replaced 0 <br />0 <br />Net estimated values upon completion of prdect 7 <br />725,000 <br />SECTION • • AND OTHER B <br />BENEFITS PROMISED BY THE TAXPAYER <br />Estimated solid waste converted (pounds) 0 E <br />Estimated hazardous waste converted (pounds) 0 <br />Other benefits <br />SECTION 6 TAXPAYER CERTIFICATION <br />I hereby Certify the is representations in this statement are true. <br />Signatureorau T <br />Title D <br />Date signed (m fh, y. year) <br />11 <br />Page 1 of 2 / / <br />