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STATEMENT OF BENEFITS 20 PAY 20 <br /> REAL ESTATE IMPROVE#AENTS — <br /> sLra Form 51797(R412-13) FORM 81.1 I Real Property <br /> PreScMed by U1®Department 0t Looal COmTxnenl Finanoa <br /> PRIVACY NOTICE <br /> This etmternonl Is betng completed for real property that qualllm trader the fobov*V hldians Code(ctwck one box): TTm r"or srtd•ny specft*td?vidlut's <br /> ❑ Redeyebprnartt or rehobftDon of real ealete Imprvvernsnls(IC 8.1.1.121-4 •scary MroTmalan Is confldenMe rte <br /> bwance d Ue fkg is pubfIc lwN[:1 ReskienUeRydWreasdewVC&1.1-12.1-0.1) d <br /> A. <br /> INSTRUC7raas: <br /> 1. 7hls aYelarneM musr be auD,rsfnad ro Ma body dlsa(prreo4tg the Econornt rTevRarpratlon area prior to the pub 1e rroeM7g M fire daslgrlating b«N raquhe5 <br /> Intannation born the applicant In making its docision about whet her to de:rbWe an Ebwornb Ravaetradon Area. Oftlerwtse,this atatem"must be <br /> submitted to the destneting body BEFORE the redevelopment or mhabhNatkn ofrcal property for tvhkh the person wishes to claim a deduction. <br /> -Pr ctsI plennod orcommWedto a Mar JOY 1.1987,and areas designated aNet rJ*1,1987,re9 e o STATEMENT OF BENEFITS. (IC 6.1.1-121) <br /> 2 ,Approval of the destgmafrng body(CffY COWWI,,Taws Board,County Ccunrdl,ato.)must be obtained prior fa MIRAtlon of the redovalopmanI or <br /> relieb6yellm,BEFORE adeducllon maybe Approved, <br /> 3. 7b obfah a avve 07,a form 32ME must be lead wRh Ma CmVyAutRor.belbm May 101n the yeor In witkh the addillon to assessed value lion Is <br /> made or not later than thirty(90)days allerthe assessment notice Is mailed to the propertyownerl/A.was ma8ed of rApril 10. irthe property owner <br /> misses the May i0 deadline in the Inrilel yearot occupation,he can apply between March 1 and May 10 of 6 subsequent year. <br /> 4. Properly owners whose Statermenl of Benefits was approved after June 30,1991,must anach a form CF-IlReal Property annually to the epplicelkn to <br /> show compliance Oh the Stalentent of BeneNs. (!C 6-1.1-12.141(b)and IC Pr1.1-12.1.6.3(j7J <br /> 5. The schedules rstabllshed urxlerlC r,1-1.121-4(d)rot mhablA7aledpreperty Apply lo any ec6n4mlarevltaG2ation areas doslgnaledaAer lim 30,2000, <br /> ursbas en aRernadlae dedLrtion srxledug re adopted by the dralgriNk►p body(1G 6 1.i-12.i-17), The achedates effective prof to July 1,2000,shall <br /> corona to appry to rconomic rintaftedan ereas desouted bebre July 1,2000. <br /> NW*of rapayer <br /> Rni•Y1u Cn•,uC <br /> Makes nt laxpsyer(numberend Mraal.dfX stab.anrl7rP tzxteJ _ �` <br /> 835 s.txlsya•eo dw—d,awn taend,k.1"40801 <br /> .141 me of con!sct Person 'kkphone nxnber E-ree address .. .. <br /> S11• E Pewroan (571 ) 387-72e2 •.p•isrerl .dcwy,r.tom <br /> N•me M d-sgmnng body <br /> South Bard C lromurr i bad•1 Resolulbn wumbrr <br /> orn do d vtip" Courtly otcF twerp district number <br /> w5 3,S.Lei g•6s la"vwd.Safi efd sdwe 40001 SL.k••ph C—Ry <br /> pn!,crrplre:,of real property lmproyemePrs,redeVMOpTanr.Of rchat-4,!1ban(uso•dC.irnar saeefe if re cessary) EsUmaled SMrl date month, <br /> ( dsilltarl <br /> 1211571015 <br /> roe,Mxrb.md One(1)•nd T?v"(3).iif M m Vm r•cord•d PM or FtENAISSAHCE MINOR Sl19Crvrsiou,• 1011115 Oae No'1520M Earrnated eorrlpieft dale(mar al ay:leer) <br /> 31=7 <br /> Curren number S•SsMs Munb•r rNsH•d Salarlos Ih'�mber adcfi:o ,4 Uarles <br /> 05 e5 20 <br /> a• <br /> REAL ESTATE fh1PR_O_VEMENZ6 <br /> COST ASSESSED VALUE <br /> Current values <br /> Plus esl rated values of proposed pro c( _ 9 s/S/(e r ZSa <br /> Less values of any rty being roplelxd- - --- so <br /> Not eslltnaletl values upcn CorrveUon of pr act /D 7-9 ec So <br /> EatkImted goad waste corralled(Pounds) WA --- Esthnated hazardous waste converted(pounds) IAA <br /> Olherbeneeis - - - <br /> Th•AvJW vA0 ravA In Ow radevvtopnent•rd rshat41AUon or Studebakm euidhya 112 aid 113 and p wAU ee%i phr d d•wlop oo M lamer Shrd•ee•sr A.-nt y�y(ivy Toes) <br /> slhr Tlds proJsctw a proviso ee rgJsad s+urRY.lnir•e1 1cM1ea and Iritial ps miry)b r•ut=!1s•e w txAeans rd mnrtence ns rwaizsaon a me onqu.The rt•a a txoardaU tRs vddM has <br /> Men mos9y wn•dakd srd undn rxiz•d endyr vaunt ernee Stud!5e4..fa dmxs 52 ysrs•po. <br /> 1 hereby Certtty that the representations In this stale,ent are bue. <br /> WV*d(mourn.MK read-� <br /> Page 1 o!2 <br />