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<br />STATEMENT OF BE IEITS
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<br />PERSONAL PROPERTY
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<br />Slate Form 51764 (R / 1 -06)
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<br />Prescribed by the Department of Local Government Finance
<br />INSTRUCTIONS:
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<br />FORM SE -1!PP
<br />1 } PRIVACY NOTICE I
<br />The cililst and any specific individual's
<br />salary nformalion is confidential; the
<br />Wan of the filing is public record
<br />per IC 1,1- 12.1 -5.1 icl and (d).
<br />1. This statement must be submitted to the body designating the Economic Revita 'zaton Arme n fc hearing if the designating body requires
<br />information from the applicant in making its decision about whether to designate an ceraerrriC Tevitaliration Area. Otherwise this statement must be submitted
<br />to the desiynating body BEFORE a person instalis the new manufacturing equipment and /or research and development equipment and/or logistical distribution
<br />equipment and/or information technology equipment for which the person wishes to claim a deduction. 'Projects 'planned or committed to after July 1, 1987,
<br />and areas designated after July 1, 1987, require a STATEMENT OF BENEFITS. (1G 6- 1.1 -12. f)
<br />2. Approval of the designating body (City Council, Town Board, County Council, etc.) must be obtained prior to installation of the new manufacturing equipment
<br />and/or research and development equipment and/or logistical distribution equipment and/or information technology equipment, BEFORE a deduction may
<br />be approved
<br />3. To obtain a deduction, a person must file a certified deduction schedule with the person's personal property return on a certified deduction schedule (Form
<br />903 -ERA) with the township assessor of the township where the property is situated. The 103 -ERA must be fled between March 1 and May 15 of the
<br />assessment year in which new manufacturing equipment and/or research and development equipment andlor logistical distribution equipment and /or
<br />information technology equipment is installed and fully functional, unless a filing extension has been obtained. A person who obtains a filing extension must
<br />file the form between March 1 and the extended due date of that year.
<br />4. Properly owners whose Statement of Benefits was approved after June 30, 1991, must submit Form CF -1 / PP annually to show compliance with the
<br />Statement of Benefits. (ICU-1.1-12,1-5.6)
<br />5. The schedules esfablished under IC 6 -1.1- 12.1- 4.5(d) and fe) apply to equipment installed after March 1, 2001. For equipment installed prior to March 2,
<br />2001. the schedules and statutes in effect at the time shall continue to apply. (1C 6- 1.1- 12.1 -4.5(o and (g))
<br />Name of taxpayer
<br />Address of taxpayer fnumber and street, city, state. and ZIP code) 2
<br />Name of contac�jperson
<br />Telephone number
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<br />0 o cl t e; • e
<br />Narne at designating b dy /
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<br />Resolution number (s)
<br />N rA h ant it i G t L—
<br />Location of property
<br />S>n M � t�5 d
<br />County
<br /><11- :OS £
<br />DLGF taxing district number
<br />Description of manufacturing equipment and/or research and development equipment ESTIMATED
<br />and/or logistical distribution equipment and /or information technology equipment,
<br />(use additional sheets if necessary) START GATE COMPLETION LATE
<br />Manufacturing Equipment I �O
<br />SWl�jS L i t
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<br />J4 G`� a i �vt -S R & D Equipment
<br />G1
<br />Logist Dist Equipment
<br />IT Equipment
<br />T, l a:r -, %y� :- - ®• n r V. ; *w l§y ar
<br />Current
<br />Current number Salaries Number retained Sa €arjes Number additional Salaries
<br />, GaU • � J' 1 , fXs�t, G d a Lr
<br />t "e �� s F s a �o o e n - a• e a s
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<br />NOTE: Pursuant to IC 8- 1.1- 12,1 -5,1 (d) (2) the MANUFACTURING R S p EQUIPMENT LOGIST DIST IT EQUIPMENT
<br />EQUIPMENT EQUIPMENT
<br />_
<br />COST of the property is confidential. COST ASSESSED COST ASSESSED CO;TJ ASSESSED COST ASSESSED
<br />VALUE VALUE VALUE VALUE
<br />Current values
<br />Ir7LIS 1
<br />M roi
<br />Plus estimated values of proposed project
<br />Ir Soo , Soo
<br />Less values of any property being replaced
<br />Net estimated values upon completion of project
<br />: FRET 4R
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<br />xr s ".s'r:F�anvi..,fr�.' .Tf
<br />.,
<br />. ^
<br />Estimated solid waste converted (pounds)
<br />Estimated hazardous waste converted (pounds)
<br />Other benefits'
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<br />I hereby certify that the representations in this statement are true.
<br />Signature of authorized representative
<br />vw l 5 -LS ti
<br />Title
<br />���5
<br />date signed (month, day, year}
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<br />31CS O
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