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OSTATEMENT OF BENEFITS <br />REAL ESTATE IMPROVEMENTS <br />S State Form 51767 IN 12.13) <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 />O Residentially distressed area (IC 6 -1.1- 12.1 -4.1) <br />INSTRUCTIONS: <br />1. This statement must be submitted to the body designating the Economic Revitalization Area prforto 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 of committed to after July 1, 1987, and areas designated after July 1, 1967, require a STATEMENT OF BENEFITS. (IC 64.1 -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 <br />rehabilitation, BEFORE a deduction may be approved. <br />3. To obtain a deduction, a Form 3221RE must be filed with the County Auditor before May 10 in the year in 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 ownerif it was mailed atterApril 10. If the property owner <br />misses the May 10 deadline in the initial year of occupation, he can apply between March 1 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 -1 /Rea) 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 - 5.36)). <br />5. The schedules established under IC 6-1.1- 12.1 -4(d) for rehabilitated property apply to any economic revitalization 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 />SECTIOA 1 WAPATER INFORMATION <br />Name of taxpayer <br />Swing- Batter -Swing LLC <br />Address of taxpayer (number and street, city state, and ZfPcode) <br />501 W. South Street, South Bend, IN 46601 <br />Name of contact person Telephone number <br />E -mail address <br />Joe Hart ( 574 235 -9988 <br />jhart@silverhawks.com <br />SECTION 2 LOCATION D DESCRIPTION OF PROPOSED PROJECT" <br />Name of designating body <br />Resolution number <br />Location or property <br />County <br />DLGF taxing district number <br />501 W. South Street, South Bend, IN 46601 <br />St. Joseph <br />Description of real property improvements, redevelopment, or rehabilitation (use addieonalsheers irnecessary) <br />Estimated start date (month. day. yeafj <br />10/1/2014 <br />Estimated completion date (month, day, yeeq <br />4/1/2015 <br />Cumentnumber Salaries <br />Numberrelamed Salaries Number additional Salaries <br />0 N/A <br />3 $85,000+ <br />REAL ESTATE IMPROVEMENTS <br />COST <br />ASSESSED VALUE <br />Current values <br />� <br />Plus estimated values of proposed project <br />Less values of any property being replaced <br />0 <br />Net estimated values upon completion of project <br />Estimated solid waste converted (pounds) Estimated hazard ast rA e - <br />9 <br />Other benefits <br />See attached sheet <br />r 1 2094 <br />JOHF V66' +.4^g <br />CITY CLERK, SOUTH SEND, IN <br />SECTION 6 TAXPAYER CERTIFICATION <br />I hereby certify that the representations in this statement are true. <br />Signature araulhodzed represenlatHe <br />iNe <br />Dale signed (month, day, year) <br />Page 1 of 2 <br />