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STATEMENT OF BENEFITS <br />REAL ESTATE IMPROVEMENTS <br />State Form 51767 (R412 -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 />❑ Residentially distressed area (IC 6- 1.1- 18.14.1) <br />20 PAY 20__ <br />FORM SB -1 I Real Property <br />PRIVACY NOTICE <br />Therms) 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. 12.1- 5.1(c) and (d). <br />INSTRUCTIONS <br />1. This statement must be submitted to the body designating the Economic Revitalization Area prior to the public hearing ifthe 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 or committed to after July 1. 1987, and areas designated after July 1. 1987, require a STATEMENT OF BENEFITS. (IC 6-1.1 -12.1) <br />2. Appirival of the designating body (City Council,. Town Board, County Council, etc) must be obtained prior to initiation of the redevelopment or <br />rehabilitation, BEFORE deduction maybe approved <br />3. To obtain a deduction, a Form 3221RE must he filed with the County Auditor Before May 10 in the year in which the addition to assessed valuation Is <br />made or not laterthan thirty (30) days afterthe assessment notice is mailed to the property ownerif d was mailed afterApr810. Ift6e property owner <br />misses the May 10 deadline in the inkfal 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 attech`a Form CFAA2eal Property annually to the application to <br />show compliance with the Statement of Benefits. 11C 6.1.1- 12.1- 5.1(b) and /C 6- 1.1- .12.1- 5,3p)]. <br />5. The schedules established under IC 61:1- 12.1 4(d) forrehabflilatedpmperty apply to any economic nev8alizatlnn areas designated after June 30, 2000, <br />unless an alternative deduction schedule is adopted by the designating. body (IC 6 1.1421 -17). The schedules effective priorto July 1. 2000, shelf <br />continue to apply to economic revitalization areas designated before July 1, 2000. <br />SECTIOA 1 TAXPAYER INFORMATION <br />Name of taxpayer <br />Amenplex Supenor Panders, LP. <br />Address of taxpayer (number and street city. slate, and ZIP Code) <br />227 S. Maln Steel Suite 208 South Bend, IN 46601 <br />Name of contact person %lephone number <br />E -mail address <br />Marten Tope ]4 -2174 <br />{ `-)J6 <br />mbpeQlwladayproperaes.com <br />• • • I a • • •••• I ••• <br />Name of designating body <br />Resolution number <br />City of south Send <br />Location of property County <br />DLGF taxing district number <br />5231 Dylan ON.. South Bend, IN St. bseph <br />Descriplion of real property improvements. redevelopment, or rehabilitation (use addiemral sheets If nece ) <br />Estimated start data (mdNh day. yea,) <br />May2015 <br />me existing building will mealm an additim of 60,770sf. <br />Estimated completen data (momt day, yea,) <br />Augus12015 <br />Current number Salaries Numberrelained <br />Salaries Number atldifionel Saltines <br />62 82.086,220 62 <br />$2,066,220 8 5425,000 <br />• <br />MEN= a <br />gius jujue - a --• <br />REAL ESTATE IMPROVEMENTS <br />COST <br />ASSESSEDVALUE <br />Current values <br />53,500,000 <br />53,253,100 <br />Plus estimated values of proposed project <br />$2,100,000 <br />$1,600.080 <br />Less values distill property being replaced <br />Net estimated values upon completion of project ss,6og0oo 54,753,100 <br />1111111144211111110 • a • • • • a <br />Estimated solid waste converted (pounds) Estimate - converle�.(pgg <br />Other benefits <br />tit( -.�7 Cpt5 <br />JOHN Va teAWE <br />CITY CLERK, SOUTH SEND, IN <br />N MINE <br />I hereby that the entations in this statement are true. <br />Signature ofau i tepr <br />Title <br />Year) <br />Dale signed (mo�n{M <br />^.'daX <br />Q f <br />_ - Page 1 of 2 <br />