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Filed in Clerk's Office <br /> STATEMENT OF BENEFITS - -° 20 PAY 20 <br /> t REAL ESTATE IMPROVEMENTS <br /> State Form 51767(R412-13) AUG 0 8 2018 FORM Sli/Real Property <br /> �' •° Prescribed by the Department of Local Government Fina ce <br /> i �1`^, PRIVACY NOTICE <br /> This statement is being completed for real property that qualifies under th followit AH ( lY¢CX e ) The cosL and any specific individual's <br /> ❑ Redevelopment or rehabilitation of real estate improvements(IC 6-1.1 1 4��I cLE�I< sou-�I�AEI IN salary Information Is confidential;the <br /> Y __. balance of the filing is public record <br /> ❑ Residentially distressed area(IC 6-1.1-12,1-4.1) I _. ..----• per IC 6-1.1-12.1-5.1(c)and(d). <br /> INSTRUCTIONS: <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 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, 1987,require a STATEMENT OF BENEFITS. (lC 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 <br /> rehabilitation,BEFORE a deduction may be approved. <br /> 3. To obtain a deduction,a Form 3221RE must be filed with the County Auditor before May 10 in the year in which the addition to assessed valuation is <br /> made or not later than thirty(30)days after the assessment notice Is mailed to the property owner if it was mailed afterApril 10. if the property owner <br /> misses the May 10 deadline in the initial year of occupation,he can apply between March 1 and May 10 of a subsequent year, <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 6-1.142.1-5.30)1. <br /> 5, The schedules established under iC 6-1.1-12.1-4(d)for rehabilitated property apply to any economic revitalization areas designated after June 30.2000, <br /> unless an alternative deduction schedule is adopted by the designating body(iC 6-1.1-12.1-17). The schedules effective prior to July 1,2000,shall <br /> continue to apply to economic revitalization areas designated before July 1,2000. <br /> Name of axpayer 7 <br /> Address of taxpayer(numberand street,city state,and ZIP code _ <br /> Name of contact person Telephone rumber E-mail address <br /> oe L4 _lk U7 tie' <br /> Name of doena6ng bo/d�y Resolution number <br /> t Cecut e.r.-P <br /> Location of grope County DLGF taxing district number <br /> 38 A�, <br /> Description of real property improvements,redevelopment,or rehabilitalion(use additional sheets it necessa Estimated start date(month,day.year) <br /> 'e";I, -5v <br /> y! Estimated completion date(month,day year) <br /> Currenlnu ber S.laries NLm rrela'.ned alaces Njmberaddit`onal Salariesf <br /> �� 35,�oo-tlorooa �, 351oob IID oe� Z S 35,.. Ilotaoa <br /> REAL ESTATE IMPROVEMENTS <br /> COST ASSESSED VALUE <br /> Current values Pues xyv o <br /> Plus estimated of pr oposed project / OOc7 <br /> Less values of any property being replaced <br /> Net estimated values upon completion of project 41 zI SKIN I <br /> Estimated solid waste converted(pounds) Estimated hazardous waste converted(pounds) <br /> Other benefits <br /> SECTION 6 TAXPAYER • <br /> I hereby certify that the representations in this statement are true. <br /> Signature of authorized representalivadz, /� Title t Dale signed(month,d y,year <br /> \ ��� c Qq Q_ T l W <br /> Z!�0 k �" Page 1 of 2 <br />