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`°��" STATEMENT OF BENEFITS <br /> ao IsA�ao <br /> � _ REAL ESTATE IiVIpR®VEI4�ENT5 — <br /> .� State Form 51767(R2 l 1-07) FORM SB-t 1 Reai 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 6-1.1-12.4-4.8) <br /> INSTRUCTIONS: <br /> 1. This statement must be submitted to the body designating the Economic Revitalization Area prior to the public hearing ifthe 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 <br /> submitted to the designating body BEFORE the redevelopment or rehabilitation of real property for which the person wishes to claim a deduction. <br /> "Projects'planned or committed to after July 1, 1987,and areas designated after July 1, 1387,require a STATEMENT OF BENEFITS. (fC 6-1.1-12.1) <br /> 2. Approval of the designating body(City Council, Town Board, County Council,etc.)must be obtained prior to initiation of the redevelopment or rehabilitation, <br /> BEFORE a deduction may be approved <br /> 3. To obtain a deduction,application Fort 322 ERA/RE or Form 322 ERA/VBD, Whichever is applicable,must be filed with the County Auditor by the later <br /> of.-(1)May 10;or(2)thirty(30)days after the notice of addition to assessed valuation or new assessment is mailed to the property owner at the address <br /> shown on the records of the township assessor, <br /> 4. Property owners whose Statement of Benefits was approved after June 30, 1991,must attach a Form CF-1/Real Property annually to the application to <br /> show compliance with the Statement of Benefits. (1C 6-1.1-12.1-5.1(b)and IC 6-1.1-12,1-5.36)] <br /> 5. The schedules established under 1C 6-1.1-12,1-4(d)for rehabilitated property and under IC 6-1.1-12.1-4,8(1)for vacant buildings apply to any statement <br /> of benefits approved on or alter July 1, 2000. The schedules effective prior to July 1,2000,shall continue to apply to a statement of benefits filed before <br /> July 1,2000. <br /> Name of taxpayer <br /> lv t --1zM v Q ` <br /> Address of taxpayer(number an street,city;state, nd ZIP code) <br /> re o�anr r lt' >�r. tv7 0n t' <br /> Name of contact person t� i/a✓ P,4'a ", Telephone number E-mail address <br /> s • • • � s a -s•r a •-• <br /> Name of dF(esignating body Resolution number <br /> Location of property Count <br /> 1 Y DLGF taxing district"umber)d mfr �� �T S bs_. a 'a TOcij r <br /> Description of real property improvements,redevelopment,or reh4ilitation(use additional sheets if necessary Estimated start date(month,day,year) <br /> /7 / Estimat completion date(month,day,year) <br /> � �.� GS, 1"ar r G t i �-r n.�.�p� JJ a�j ed*�+*.-�.'� <br /> • • • s •e-e o •s <br /> Current number Salaries Number retained Salaries Number additional Salaries <br /> • r r s q r -r•s r •-s <br /> NOTE:Pursuant to iC 6 1.1-12.1-5.1 (d)(2)the COST of the property REAL.ESTATE IMPROVEMENTS <br /> is confidential. COST ASSESSED VALUE <br /> Current values <br /> Plus estimated values of proposed project <br /> Less values of any property being replaced <br /> Net estimated values upon completion of project <br /> s • s e s 2111 <br /> Estimated solid waste converted(pounds) Estimated hazardous waste converted(pounds) <br /> Other benefits Filed In ii,*4-n Off joe. <br /> JUL <br /> JOHN <br /> I LEAK, <br /> I <br /> r <br /> I here y certify that the representa' ns in this statement are true. <br /> Signatur of a ihor' d re asenta(e Title Date signed(month,'day,year) 7 <br /> Page 1 of 2 <br />