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• �' "'� STATEMENT OF BENEFITS <br />20 PAY PAY 20_ <br />REAL ESTATE IMPROVEMENTS <br />Uzi Y State Form 69767 (R2! 1 -07) FORM SE-1 ! Real Property <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 />❑ Eligible vacant building (IC 6- 1.1- 12.1 -4.6) <br />Page 1 of 2 <br />!OA% <br />