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STATEMENT OF BENEFITS FORM SBA 1 PP <br /> PERSONAL PROPERTY <br /> c ; State Form 51764(R 11-06) <br /> • Prescribed by the Department of Local Government Finance PRIVACY NOTICE <br /> The cost and any specific individual's <br /> salary information is confideniiat the <br /> balance of the filing is public record <br /> INSTRUCTIONS. r IC 6-1.1-12.1-5.1 c and(d). <br /> 1. This statement must be submitted to the body designating the Economic Revitalization Area prior to the public hearing it 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 submitted <br /> to the designating body BEFORE a person installs 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 aferJuly 1,1987, <br /> arid areas designated after July 1, 1987,require a STATEMENT OFBENEFiTS, (IC 6-1.1-12.1) <br /> 2. Approval of the designating body(Co 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 andlorintormailon technology equipment,BEFORE a deduction may <br /> be approved <br /> 3. To obtain a deduction,a person must Fite a cerlifred deduction schedule with the person's personal property return on a certified deduction schedule(Form <br /> iO3-ERA) with the township assessor of the township where the properly is situated. The 103-ERA niust be tiled between March 1 and May 15 of the <br /> assessment year in which new manufacturing equipment and/or research and development equipment and/or 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. Property owners whose Statement of Benefits was approved after June 30, 1991, must submit Form CF-7 i PP annually to show compliance with the <br /> Statement ofHenefits. (1C <br /> 5, The schedules established under IC 8-1,1-12.7-4.5(d)and(a)apply to equipment installed after March f,2001, For equipment installed prior to March 2, <br /> 2001,the schedules and statutes In effect at the time shalt continue to apply. (IC 6-1,1-12.14.5(1)and(g)) <br /> I TAXPAYER INFORMATION <br /> Name of taxpayer <br /> 1 1000 Iw ,� <br /> Address oftaxpayer(numbergndsheat,city,saN,andZfPcode) $AV p y I ANC - <br /> '1 �D J of 1C 1F�SCI It DT 14t- SU l�t F er 5 S+1A L b4 k t <br /> Name of contact person lephqoe number <br /> Susvq& "� ce l 3-59 t'7a <br /> D DESCRIPTION OF PROPOSED PROJECT. <br /> Name of designating body esolugon number(s) <br /> 0+ � N C <br /> Location of properly County DLGF taxing district number <br /> °S1©I 1aN <br /> Aescripllon of manufacturing equipment and/or research and development equipment ESTIMATED <br /> and/or logistical distribution equipment and/or information technology equipment. <br /> Luse additional sheets if necessary) A STAR Z DATE COMPLETION DATE <br /> Vic' ,%, U, A!!S.WKs, tai '(LS ��13..1r t,ff�e �A[ �` '^ p C) t 1i ©S 3t i1 <br /> �t , p Alanufacluring Equipment <br /> yaCJt t hfC, r G.crC 7lv�k �� l � � -w"+) eCr�1 � RE,D Equipment <br /> Loglst Dist Equipment <br /> K5 . e " •i"17 �r <br /> y{rJ,'�aCdk"+ {r is qht� . 41sj r,i3 to 'Tom.�C�� s a IT Equipment O'�f i tit <br /> k SECTION.3 ESTIMATE OF EMPLOYEES AND SALARIES AS RESULT OF PROPOSED PROJECT <br /> Current number Salaries Number retained Salaries N"additional S lames <br /> NOTE:Pursuani to IC 8-9.1-12.1-5.t (d)(2)the MANUP C URING R&D EQUIPMENT OG T DIS IT EQUIPMENT <br /> COST of the property is confidential. COST i ASSESSED COST ASSESSED COST ASSESSED COST ASSESSED <br /> VALUE VALUE VALUE VALUE <br /> Current values ' - - -e" r —1�. <br /> Plus estimated values of proposed project <br /> Less values of any property being replaced a <br /> Not estimated values upon completion 2--0) >} <br /> •N NWASTE CONVERTED AND •THER:HENEFITS PROMISEDBYTH <br /> Estimated solid wasis converted(pounds) Estimated hazardous waste converted(pounds) ` <br /> Other bonetits; <br /> I hereby certify that the representations in this statement are true. <br /> signature of authorized representative Till e Data signed(month day,year) <br /> U t �� t3Z �-7 Zoi t <br />