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teas Y; STATEMENT OF BENEFITS 20-_�PAY 20 <br /> REAL ESTATE IMPROVEMENTS --- -_ <br /> Stale form 61767(R4/2-13) FORM 89•1 I Real Property <br /> ' Prescibed by the Department of Local Government Finance <br /> PRIVACY NOTICE <br /> This statement Is being completed for real property that gtralaes under the following Indiana Code(Check one box): Ina coal end any.peorte mdvidul's contldenItal;the <br /> ❑Redevetopmen(or rehabtlfledon of real estate Improvements(IC 6.1.1.12.1-4) n"am I`is public record <br /> ❑ <br /> Residentielly distressed ants(IC 8.1.1-121-4.1) per IC 6.1,1.12 1.5 1(e)end(d). <br /> INSTRUCTIONS: <br /> 1. Me statement mud be sub onRfed lo the body designating the Economic Re■ttaitrsdon Ares prior to the pubic hearing M the designating body requites <br /> Information from the applicant in making its decision about whetherfo de:NynQ.an Economic Reviler*bon Atea. Otherwise,(Ms 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 attar JJdyi.1987.and areas designated after July 1,1087,require a STATEMENT OF BENEFITS. (IC 6-1.1-121) <br /> 2 Approval of the designe1109 body(City Council,Town Board,County Council etc.)must be obtained prior fo Initiation of the redevelopment or <br /> rehablhte:ion,BEFORE et deduction may he npproved. <br /> 3. 70 obtain a deduction,I Form 32214E must be MMed eh the County Arrant be fore May 10 in the year in which the addition to assessed valuation Is <br /> made or not later then thirty(3O)days after the assessment nonce Is melted to the property owner IIt was mailed otter April iv. ft the property owner <br /> misses the Mey 10 deadline in the lnftlal year of occupation,ha can apply between March 1 and Mey 10 of a subsequent year <br /> 4. Properly owners whose Statement of Benefits was approved aterJune 30,1991,must attach a Fenn CF-Reel Property ennumiy to the application to <br /> show Compliance snub the Statement of Benefits. (IC 6-1.1-12.1-5.1(b)end IC 64,1-12.1.6.30V <br /> 5. The schedules established under IC 8•1.1-121-4(d)far rehabilitated property apply to any economic revitalization areas designated eitcrJunc 30.2000. <br /> unless e ad en sfMa deduction sdndue is adopted by the d signelkq body(IC 6.1,1-12.1-17). The schedules of ecttve prior to July 1,2000,shag <br /> continue to apply to*canon*revile ie0on arms deslplafed bebte July 1,2000. <br /> S°ic irC:J 1 -. _ _ • • uAXI`AY1:P thr ORr.1,-,II ON ,. 1ay..�a.'.-r-,.:• <br /> Name of taxpayer <br /> Roiaald one.LLC <br /> Menus of laxpayer(number and*trek idly stale.and 7.tP emir) _._ —__ <br /> 535 5.Lafayette Cawed,bout bend.Indiana 40301 <br /> Name of Contact person Iep11000 number C-md addreia <br /> Wen E PeMnon (574 )367.7262 ipaiwoone ladoeew.mm <br /> . 3L-CTrOl;c • . . . I.00ArioN AND OESCRIr;TION or•,PROPOnED PROJECTA: I.•:, ,.ai•.Zr/I4.70 M'• <br /> N•mr of ff.,gn.cng body Resolution number <br /> swan bead Cannon Counsel <br /> Location of property ----- --- County OLGF Wdng dnlriel number ---� <br /> m5 s.Letayaae Elaae.we.Sari Eland.edam react aL JaeAi Count( <br /> (Jescnplmn et real properly ImprOYemen u,redevelopment.or,rhnt'A$ntCn(use ad6tens?smelt I/ereessary) Wrested start date(month.dry.jeer <br /> 121122015 <br /> lda Nrrbwe/One(1)and Ursa Mal Anorwn m Ora recorded Thal d RER JSSANCE MINOR SUBDMSION,recorded 1011n s Doc No.15252e3 Estina rJ Cttrlplaerxl dek(more',,dry.year) <br /> 311/2017 <br /> SI;C iION i - - ==Tl61ATf?i'/ C.:4PL'Ye PES<,t)C Sf1C P.IEf AS RESULT OF,PR OPG @'1 for OJi CT'rX =are Ceti <br /> Current number &Aeries Number remained Seines NumberadOLoeN Salaries <br /> 5S 3a 20 <br /> ..-:iT•4?IC::•., - , . .'.:,ES;I:4ATEn;fOTA! AND.VALUE OF 17P,OPG9E;PR42=CT.; .,*�•_;�°_`"- <br /> _ REAL ESTATE IMPROVEMENTS <br /> COST ASSESSED VALUE <br /> • <br /> Currant values _ 8415,6'00 <br /> Plus estimated values of proposed pro ect 9,4/4/61 2-5-4> <br /> Less values of any property being replaced_ _ <br /> Net esllinaledvalues .oncorrpleuonof(JO eel /O Z9/ . �cao <br /> bccrit 7tJ S L'Jni5.r CO;V RT ED AND JTI11_f:nEr:f_PI n r 4CL44)En ia'TiiL '.XP.ATErt��s ".5t,-sisal.t>:e!'ts <br /> Estbnated solid waste converted(pounds) N/A —_-- _ Eslhmated hazardous waste converted(pounds) wit <br /> Other benefits <br /> The voY+al awl reset In the rode.atuynert and NOW:41.4ton of Studebaker eufeilt 112 end 113 aid Pb.4de the bet photo d deaeopntoa en*tit loamy SUdebe ar Aant l6'bony(Ivy Tows) <br /> site.11.11 peeled all provide M ra4 irad arurny,IMreaUwturs end Initial parking to ninths tun two tRPnga and mmmanne M reof:neon d Or antes.Ti.dale trwmdwtl salt Wadi tun <br /> Men mazy rcm.dda ed and under vaiad meat weerd dries studebekNa dossa 52 yowl no. <br /> SECTION G TAXPAYER CERTIFICATION <br /> I hereby certify that the representations In this abnormal are true. <br /> ctgo� -- 7pe Data scrod(moth.d+k reed <br /> ' Page 1 of 2 <br />