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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 stpteinenl is being qo#!etdd'Tor real ptppeftyffiat-qijaliffes under the following lhdiana.Cocke (check one box): <br />❑ kedevelopmeni or rehabilitation of real estatei . Z'oZiZt- S (!C-6-1.1--:12.14) <br />❑ Residentially distreisted area (10 6-11A-12.1-4.1) <br />1. 7. ' ' must bb$y*Ok,�# <br />77) s statomaht mu., designating ' <br />09. � . . - - If the -kiesidnaft bddy ree <br />InformatI60 Abut the apokent In mi <br />OkingrNsdapisfiJ atiptil"wh6ther to doplgppfe on EopnoMic'Revitaligafforl Area. Otherwisdthhstateffiohthn4 <br />submitted ;Ignati,7-qbo.dy,94PORE.thei�ik� qhi dii-4h6b0affion of re' t6r "kh the person'WIshiet to cishii b'dddu�iibfi, <br />ubm ad to the ei real <br />0 6ohim*id'16 idltdij�fy l,' 19U, and a 6 after July 1, 1987, require a STATEMENT OF GENE 17S. (IC 6 . - . 1.1-12.1) <br />r areas o!e 1_�hat6d' ' a <br />2. Approve! of the designating -bo'ty'* (City Council, -Town b,,q4CPUI#YCouncil, ef0.)trust <br />Ae obtained prJorto Initiation of the redevalopment& <br />rehabilitation, BEFORE adeu <br />3, 'To obtain a dedy :0, a aii, wlleiwtth thO Coubty-Audlotbefore May loin the. year in whlqh the addillonto gsse*sedQa1ddfi0n is. <br />made or rlgf laterttian thirty (30) days Is <br />did the property ownerif it was mailed afterAppil lo. ff the propelyow—fier" <br />r ro UPS Itween March I sr. <br />0 068-01h el 'I ' <br />m/886.1, a may 1. tko, he be and May 10 :of a subsequent year. <br />t <br />4" .4pe-* 6"'eii Whose ii 1091., t�4st .1 -a Form CP-IlReal Properly annually to the applicagon to <br />with P �7 rV owners Nach. <br />sh ' " P.14jog, <br />ow coop any economic desighatedafterJone.30 '2000 <br />The schedules es!ab mfializatlon areas <br />u -'s an 'ftmall" d the A&Itedules.effeclive prior to July 1,- 2000, j�a'll <br />le <br />co Lie to. <br />appi <br />continue , ytoec <br />SECTION I TAXPAYER INFORMATION <br />Name of taxpayer <br />South Bend Form Too[ Co., Inc. <br />Address of taxpayer (nomb- en# *treat, dAl state, and;ZIP code) <br />408 W. Indiana Ave.. South Bend, IN 46613 <br />Na" of contact person TTelephone numbif <br />E-mail address <br />Herb Eggers 1(574 )289-2441 <br />lb000rs@sbfoffn.corn <br />SECTION 2 LOCATION AND DESCRIPTION OF PROPOSED Pf�OJEC.V"'-' <br />Name *of designating body <br />Resolution-number <br />City of South Bend <br />Location of property <br />county <br />PIJGF taxing district number <br />1619 81623 Franklin St., South Bend, IN 46613 <br />St Joseph <br />Description of real properiy Improvements. re4evelopmdnt, or rehabilitation (use adog(wal sheets Jfnqcessary) Estimated start dalefmonft day. yeat)i <br />4/112016 <br />Construction of approximately 3,000 additional square feet of manufacturing space and Improvements to existing building Estimated pompl6tion date (—M, day, year} <br />1211=6 <br />W7kumb <br />Current number Saiarles Nurnber relained Salarlm ad Salaries' <br />$785,000 17 $785,000 $378.560 <br />SECTION4 ESTIMATED TOTAL COSTANDVALUE <br />OF PROPOSED.PROJEC.T <br />REAL EsWt ImpRovEmEsiTs <br />COST <br />ASSESSED VALUE <br />,Current values <br />$10,000 <br />$3 <br />s of.pro' sad <br />Pigs esitlinaled value.. 00000 Prq1e;t <br />$222,166 <br />$22Z166 <br />Less values-01'an ro erty'bein replaced <br />$0 <br />$0 <br />Net estimated values .upon Completion of br . o1ba <br />$232,166 <br />$253,166 <br />SECTION5- WASTE CONVERTED-AND OTHER <br />BENEFITS.PROMISED 13Y.T.HE -TAXPAYER <br />Esdirritted sofid waste cot'iVerted (pounds) <br />Estimated hazardous waste convend .(pogmc(s) <br />Other-benefits <br />SECTION 6 TAXPAYER CERTIFICATION <br />1 .. hereby I . ; ciiif y tI hiithe representations in this statement are true. <br />Signature orauthc ' ' ipresentidlVe Digitally signed by Kyle Harbison <br />Date: 2016.03.03 11:30:24 -05,00 <br />Project Manager <br />Dale signed —tmpiA, dig y.40 <br />03/03/2016 <br />Page I of 2 <br />