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STATEMENT OF BENEFITS <br />REAL ESTATE IMPROVEMENTS <br />State Form 51767 (R6 / 10 -14) <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 />Q( Redevelopment or rehabilitation of real estate improvements (IC 6 -1.1- 12.1 -4) <br />0 Residentially distressed area (IC 6- 1.1- 12.1 -4.1) <br />20 16 PAY 24 177 <br />FORM SB -1 i Real Property <br />PRIVACY NOTICE <br />Any information concerning the cost <br />of the proper and specific salaries <br />paid to indivi ual employees by the <br />property owner is confidential per <br />INSTRIJC'TIONS 1C <br />1. This statement must be submitted to the body designating the Economic Revitalization Area prior to 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 rehabilita tion of real property for which the person wishes to claim a deduction. <br />2. The statement of benefits form must be submitted to the designating body and the area designated an economic revitalization area before the initiation of <br />the redevelopment or rehabilitation for which the person desires to claim a deduction. <br />3. To obtain a,deduction, a Form 3221RE must be riled with the CountyAuditorbefore 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 owner if it was mailed afterApril 10. A property owner who <br />failed to file a deduction application within the prescribed deadline may rite an application between March 1 and May 10 of a subsequent year <br />4. A property owner who files for the deduction must provide the County Auditor and designating body with a Form CF- 1/Real Property. The Form CF- 1lReal <br />Property should be attached to the Form 322/RE when the deduction is rust claimed and then updated annually for each year the deduction is applicable. <br />IC6- 1.1-12 19 5.1(b) <br />6, Fora Form SB- ?/Real Property that is approved alter June 30, 2013 the designating body is required to establish an abatement schedule for each <br />deduction allowed. For a Form SS- 1lReal Property that is approved prior to July 1, 2013, the abatement schedule approved by the designating body <br />remains in effect. IC 6 -1.1- 12.1 717 <br />SECTION •• • <br />Name at taxpayer <br />COHN & COHN INVESTMENTS, LLC <br />Address of taxpayer (number and street, city, state, andZIPcode) <br />912 Lady Street, Suite 200, Columbia SC 29201 <br />Name of contact person Telephone number <br />E -mail address <br />Richard H. Cohn, Sr. 1(803) 699 - 1325x102 <br />richardcohn @cohnconstrudonlic.com <br />SECTION 2 LOCATION AND-DESCRIPTION OF PROPOSED PROJECT <br />Name of designating body <br />Resolution number <br />Common Council of City of South Bend <br />Location of property <br />County <br />DLGF taxing district number <br />Vacant Land - Lot 6 in Blackthorn Corporate Office Park <br />I St. Joseph <br />SB- German <br />Description of real property improvements, redevelopment, or rehabilitation (use additional sheets if necessary) <br />Estimated start date (month, day, year) <br />Investment of - $1,600,000 in the construction of an approximate 13,000- 20,000 square foot commercial distribution <br />March 1, 2016 <br />and office facility in the Blackthorn Corporate Park in South Bend. The facility is intended to initially serve and <br />Estimated completion date (month, day, year) <br />support the expanding operations of UniFirst in South Bend. <br />March 1, 2018 <br />SECTION 3 ESTIMATE OF EMPLOYEES AND SALARIES AS RESULT OF PROPOSED PROJECT <br />Current number Salaries Number retained Salaries Number additional Salaries <br />23 $923,880 1 23 1 $923,880 S - $180,000+ <br />SECTION 4 ESTIMATED TOTAL COST AND VALUE OF PROPOSED PROJECT <br />REAL ESTATE IMPROVEMENTS <br />COST ASSESSED VALUE <br />Current values <br />58,000.00 <br />6,300.00 <br />Pius estimated values of proposed project <br />1,600,000.00 <br />ReIZ 17 <br />Less values of any property being replaced <br />0.00 <br />0.00 <br />Net estimated values-upon completion of project <br />1,658,000.00. <br />Re . 17 <br />SECTION • . AND OTHER <br />BENEFITS PROMISED <br />Estimated solid waste converted (pounds) <br />Estimated hazardous waste converted (pounds) <br />Other benefits <br />1. The employment projections above are those of UniFirst, the intended occupant of the new facility. <br />SECTION • <br />I hereb4cf rti at resentations in this statement are true. <br />Signatur presentative <br />Date signed (month, day, year) <br />February <br />Printed name ofauthorized representative <br />Title <br />Richard H. Cohn, Sr. <br />Chairman <br />Page 1 of 2 <br />