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STATEMENT OF BENEFITS 20 PAY 20_ <br /> REAL ESTATE IMPROVEMEP)T3 - <br /> 9tsu Fate 51797(R412.13) FORM 89-1 1 Real Property <br /> Prescribed by Ute Deparlmonl or Local GovenniTtenl Fkwlice --- <br /> PRIVACY NOTICE <br /> This stelemartt Is lb&0 g cotnpd®tad For meal pro"rty viat gtwjMw lA-KW ft robe lw Indfmta Code(check one box): The coot and any apedtb eedivedunl's <br /> ❑ Redevelopment or rehobftUm of real estate knprovan ants(IC 6.1.1.12.1-4) busty e o the Qk k s pub hac ere <br /> balance or the fdirq is public nerord <br /> ❑ ReaWelll e#y distressed am(1C&1.1-12.1-0.1) oar IC 61.1.72.1-5 Ile)"td). <br /> INSTRUCThm <br /> 1. This d& mart mndt be aubnafted to Me body dast ry the Eooaw*Revft&atbn Area Prior to the Public hearing Nth.deslpnennc body Mgtrdes <br /> tnforrrtatlon from the applicant in making its decision about whether to dad VW#an Econotnb 8Wn Area. OthOnvilsa,Ihls statement must be <br /> submitted to the destgneftng body BEFORE the redevelopment or rahablRfallon ofreal property for ivhkh the person W&fies to claim a deduction. <br /> TP q*cts`planned orcommnMd to arterJdy i,1887 and areas designated after July 1,1987,require o STATEMENT OF BENEFITS, (11364.1-121) <br /> 2 App rovef of the deskmfh q body(CV Co WWI.Town BoaA County Council.eta)must be obtalrted prior to lnHralbn of lily Mdevelopment or <br /> rehabilltallbo,BEFORE a deduction may be epproved. <br /> 3. Tb obtain a dsMUdbn,a Form 31214E must be t)tad*0 the CountyAWilorbefore May 10 in the year In whtdl the addition to assessed valuation is <br /> made or net later than thinly(30)day%after the asseismailt nolice is mailed to the pipperily owner Ifft was mailed aftrApfil io. ir(he property owner <br /> misses the May 10 deadline in the InNal year of occupatbn,he can apply between March f and May 10 ofa subsequent year. <br /> 4, Property owners whose Statement of Senef:U was approved after June 30,1991,must attach a Porn CF-1AReal Property annually to the epplkatfon to <br /> show compliance wffh the Statement of Banefits. (IC 6-1.1-12.1-31(b)and IC 6 i.9-12.i•6.3{�7J <br /> 5. The Schedules t-stabltsiled underIG 6-t 1.121-4(d)far rehabihleted property Apply to any economic revilaGza(Ion areas designated eAer hnw 30.2000, <br /> unlass an aaftmadve dedurtlan Sdwgk*is adlptod by ft dssV*ky body(IC G 1,f-i2.f-1 r7. The schedules effective pdor to July 1.2000,shall <br /> corO?ue to apply to economic relrfalkellon areas dDSOMfed Wom July 1,2000. <br /> Name d tdgw <br /> Memo!one,LLC <br /> AdBra eaoflaxpsyer(numberandahsal.d1ysfak"andZiPmda) -- - —~ <br /> w5 a.Lataysee Bmisr—d,S.Ah BMA,InA ns 4eee1 <br /> Marne o{Ca1lKtpetson ltkephona rximhet E-mea address <br /> SMart E Pwanrm (574 ) 387-7M2 �.rn•n <br /> Name of A•Igna6ng Lady ResoNlbn n11t11bK <br /> Saual Bend Camnan COtsael S` <br /> Loolto n or prOpelly - -- County OIGP fmtkg deftiet number <br /> 0.15 3.Lehyaea Bwtlsysrd,Smsh Barak I 4=1 SL Jasem COX" <br /> Descophei of real Properly lmproYementa,rodevMOPmanl er rehabriftWn(ose AdWenar sheets Irdeeeasary) --- EsameW scan dale(month,days jWd <br /> 171ISMI5 <br /> Lc&Nunbww ore(1)and Twee f3)a sfamn on use recorded Pbt of RE"SSANCE Let,DR SUBrAVr4GH,ramrdad 1or1n5 toe No.1526199 Fatinared ourtlNdon d+k(mm61 dnt>t� <br /> 3IVi-J77 <br /> Cuurnl nun4>er �S3':=.d_ NumLwnYhed Salnha <br /> 05 <br /> 1 a 1 a • 1 <br /> RFAL ESTATE IMPROVEMENTS <br /> COST ASSESSED VALUE <br /> Currant values <br /> Pius p6(lmated values otpfoilosed pro ac!. - _ 9•s/s/!e, ZSa <br /> Lees Values of art)progedy being rep)atxd ___ so <br /> Net esill-vated values on CompfeUon of ect 70,:7Z <br /> Eatimaled sold waste convened(po(47da9 WA Esllmated ttazardam waste converted(pounds) WA <br /> Paler betr_fAs <br /> rh a pretecl vAl mvA In Ow redevstopmeni sib tahs WU1;on of Studehakat Buidinps 112 ant 113 atsd pro�hfs use"phase d dMapn�1 rn M Iomrr Saulssasar Asa't1f family(ivy Tolrer) <br /> sic.TNf prated vNl prayslO the RQtLr•d f•aufty,#draatruc4rre and k4Eat parhlag b rstltfaz•asese Asa t ffl,%,n card mmm ee N rwtnzason or tie canons.The dla Is s taewnaM!sea w id r has <br /> been mosw rdn.e4W and caber of-seed and'or Vacant trace SludebekMa dvsrse 52 ye.ta ago. <br /> TAXPAYER CERTIFICATION <br /> 1 hereby certify that the rspreaentatlons in this statement are h le. <br /> /1-� ---- 71/a - - ❑e la IIQ7ed(mor+fn,rise r+r)�—- <br /> Page 1*r2 <br />