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_ _ Plea i h 8 tr�t <br /> EMENT OF BIE-NEHT 20 PAY 20 26'1~ dr y RfIE,AL ESTATE 2il�MURZ®�9E�If3ENTS 2 <br /> State Form 51767(R6 110-14) Al 1 1 2010 F02M SS-11 Real Property <br /> Prescribed by the Department of Local Governme t Finance <br /> PRIVACY NM MICE <br /> This statement is being completed for real property thatquallffes under the t6�dWft�q]'q ah"Y 7,?t� one bog): Any intormauon conceming me cost fi <br /> /'d Redevelopment or rehabilitation of real estate improvements(IC G 1`I-�2`9` °` `��`h"per� - ' of me progcrty and specific salaries <br /> (_1 esidentialiy distressed area(IC 6-1.1-12.1-4.1 r C5'i til._�rl�;U t H h; NID� i!\l f paid to In ividual employees by the <br /> _ -•,•_ raperiy owneris wnndenlial per <br /> INSTRUCTIONS: PC 6-1.1-12.1-5.1. <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 malring its decision about whether to designate an Economic Revitalization Area. Otherwise,this statement must be <br /> submitted to the designating body BEFORE the redevelopment orrzhabiNation ofreal piopedyfor which the person wishes to claim a deduction. <br /> 2. The statement of benefits farm must be submitted to the designating body and the area designated an economic revitalization area before the initiation or <br /> file redevelopment or rehabilitation for which the person desires to claim a deduction. <br /> 3. To obtain a deduction,a Form 3221RE must be flied with the County Auditor before May 10 in the yearin which the addition to assessed valuation is <br /> made or not later than thirty(30)days ah'erthe assessment notice Is malted to the property ownerif it was malted afterApr110. A property owner who <br /> felled to file a deduction application within the prescilbed deadline may file an application between March 1 and May 10 of a subsequent year. <br /> 4. A property owner who files forthe deduction must provide the CountyAuditor and designating body with a Form CF-1/Real Property, The Form CF-1/Real <br /> Properly should be attached to the Form 3221RE when the deduction is first claimed and then updated annually for each year the deduction is applicable. <br /> iC 6-21-12.P-5.1(b) <br /> 5. For a Form S8-1/Real Property that is approved after June 30, 2013, the designating body is required to establish an abatement schedule for each <br /> deduction allowed. For a Form SE-1/Real Property that Is approved prior to July 1, 2013,the abatement schedule approved by the designating body <br /> remains in effect. IC 6-1.1-12.1-17 <br /> Namaofttt'A F I <br /> Address of faxdpayer(number and street,ci�slats and 74P code) <br /> 3(e. 7 /4 <br /> Name of contact person Tie lapho a number E- ail address / GJ�� <br /> Name of do Ignating=1i13� f U':[t�fJ1 (ieyln-A o ••o•o a 1✓p11,1MUiJ GI Resolutfonnumber <br /> Location of property I County, I DLGF taxing disbrict number <br /> O� Su6Al�lSio,y Sy . 500P h V OZ(v-S� for <br /> Descriptlon of real property improvements,redevelopment,orrehebllliation(use additfonalsheets irnecesswy.) FsGmated start date(month,day,year) <br /> S—J_lt4 _7) ST�� � ►� Dit�l� w uMp�aG v,tO 64446c <br /> Cc' i Irk INL� P l�}C J � SE'Jai. 1► U�r73P� C��rel��56 �^ .6 Esgmale completion date(month,day,year! <br /> SE Sp ��� ltv� vpE Cd;�rp0mmjiwn Itur,7't-F,gn�r 24A,&CjgL J u) 3) Zc�1 <br /> ESTIMATE OF • AND RFSJLl'OF-PR,0POSt0 PROJECT <br /> Currenlnumber- Salaries Number retained Salaries Numberaddillo Ssiaries <br /> --,7-72 Mlturrivit� <br /> 4. <br /> ESTIMATED 7(jIAL COSTAND VALUE OF PROPOSEr,PROJECT <br /> REAL ESTATE IMPROVEMENTS <br /> v COST ASSESSED VALUE <br /> Current values 10 <br /> Plus estimated values of proposed project 3X01 61M <br /> Less values of any property being replaced <br /> M values upon completion of project <br /> CONVERTED o PROMISED : <br /> id waste converted(pounds) f`) 7 Estimated hazardous waste converted(pounds) Yv <br /> Ot <br /> ��rdjolv': • <br /> i hereby certiry at the represe •ons in this statement are true. <br /> Signature of aut d r - enlati a Dais signed( nth,daK_�_o ear) <br /> I I I <br /> Prin ame of out r ed rap esentallw Title L�G4 <br /> Page 1 of 2 <br />