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a y4~u`2 i?sq; ~7p:'~'k•'v <br />FI~~:~ ~~~ G y ~~_ ~_~ <br />~"^ ~, STATEMENT OF BENEFITS ~ FORM SB-17 PP <br />x[ `~~ l~ PERSONAL PROPERTY ~ C pp _ ~ ,r;;~$ <br />+:~,,,~f ° State Form 51764 (R / 1-06) ` F J 4' . LV PRIVACY NOTICE <br />'°~• Prescribed by the Department of Local Government Finance <br />The cost and any specific individual's <br />salary information is confidential; the <br />Jl~i'PJ ~rQQyC~ balance of the filing is public record <br />INSTRUCTIONS: CIT'{ Qis"i{C, SQ• ~EkD, Id• per IC 6-1.7-12.1-5.1 (c) and (d . <br />1. This statement must be submitted to the body designating the Economic Revitalization Area prior to the public hearing 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 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 after July 1, 1987, <br />and areas designated aRerJuly 1, 1987, require a STATEMENT OF BENEFITS. (IC 6-1.1-12.1) <br />2. Approval of the designating body (City 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 and/or information technology equipment, BEFORE a deduction may <br />be approved <br />3. To obtain a deduction, a person must file a certified deduction schedule with the person's personal property return on a certified deduction schedule (Form <br />103-ERA) with the township assessor of the township where the property is situated. The 103-ERA must be filed 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-1 / PP annually to show compliance with the <br />Statement of Benefits. (IC 6-1.1-12.1-5.6) , <br />5. The schedules established under IC 6-1.1-12.1-4.5(d) and (e) apply to equipment installed after March 1, 2001. For equipment installed prior to March 2, <br />2001, the schedules and statutes in effect at the time shall continue to apply. (IC 6-1.1-12.1-4.5(tJ and (g)) <br />• •' • <br />Name of fax ayer ~.~( i <br />~C <br />~ <br />i~2 <br />~~c~ ~tl C <br />L <br />I ~lC <br />:~~ <br />a <br />, <br />l c,n <br />Addr~s~~ Ly~(numbera^~ ,cijy,,sf~e,andZlP,~~j~~~ ~_g <br />IV` ' 11T ~ Y D ~ <br />/ <br />Name <br />of contactperson <br />Rv~~ ~.~~~~~ ~~~s~v~n ~ Tele ho a number <br />a~~ ~aa~ <br /> <br />Name o designating body <br />~v n~ <br />S <br />~ ~ <br />~ Resolution number (s) <br />oy <br />~ <br />~ <br />Locatio of ro erty ~'`uJ7 <br />3~~~ ~J:-u-rAM i2~~Nl~ ~ ' ~ ~f lo(o~ County ~ ~ <br />~ SoS~ P DLGF taxing district number <br />Description of manufacturing equipment and/or research and development equipment ~ ESTIMATED <br />and/or logistical distribution equipment and/or information technology equipment. START DATE COMPLETION DATE <br />(use additional sheets if necessary) <br />~~. ~~.,~^~, t i ~ ~ Manufacturing Equipment ~ a~~ ~ ~d~Q <br />fl~-~ <br />_ ~ • R 8 D Equipment --- <br />Logist Dist Equipment ~ I ~~j ~ ~ ~} <br />IT Equipment aQ(~ a0 <br /> <br />Current number Salaries O Number reO Salaries O Numb@r ~dd'Rionat Salari ~, <br />'l <br />• ~ • • ~ • -~•• ~ •-• <br />NOTE: Pursuant to IC 6-1.1-12.1-5.1 (d) (2) the MANUFACTURING R & D EQUIPMENT LOGIST DIST ~ EQUIPMENT <br />.EQUIPMENT EQUIPMENT <br />COST of the property is confidential. COST ASSESSED COST ASSESSED COST ASSESSED COST ASSESSED <br />• VALUE VALUE VALUE VALUE <br />Current values <br />Plus estimated values of proposed project ~ - G~J <br />Less values of any property being replaced <br />Net estimated values upon completion of project ~ Q , OOCa r OU <br /> - <br />Estimated solid waste converted (pounds) \ Estimated hazardous waste converted (pounds) 1~ <br />" L ~ <br />Other benefits: ` S (~ ~ ~~ ~n L ~~ '-~rN~ (p ~ d{(j wj~•i ~'(V <br />~xQr/~T~p T~ C GzU A'~u ~ C7J f ~ ~ .. <br />AT~~ AN~1~A~ ~AYR~L~ p~ ~ p~j~ Q~ <br />~ + <br /> <br />I hereby certify thai the representations in this statement are true., <br />Signature a d presentative Title Date sig ed nth, da year) <br />0 <br />~ <br /> [~ 1~l'S~ ~ ~ <br />