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<br />Brownfields
<br />Project Return on Investment (ROI) Survey
<br />M wat
<br />- � s
<br />Nw
<br />Indiana Finance Authority
<br />Site Name:
<br />Brownfields site Number:I
<br />Address:
<br />,Citµ+ .. ...,
<br />litr 63uuuta?
<br />Instructions Use "x" to mark fields
<br />that do not require description or numerical values.
<br />1. Site Status No
<br />... .. . ........ m ........ ........ _.---_..-...._,,.,�......,.,..,
<br />Yes Date Describe current status of Site
<br />a Remediation Required?
<br />NA
<br />b Ramediation Complete?
<br />2.Redevelopment Status .... ......_.-- Planned....�...InPro.�..........m..�...
<br />� ... p .,.t . .r pat o
<br />Progress Completed Date that redevelopment was either completed or is anticipated to
<br />.,....... ,. - _ .......... ...... -....
<br />-. ..,,, ... ,....,. ....�. becomppcte
<br />Mark field that applies
<br />Size of Site (acreage)
<br />--- -
<br />3. Funds Leveraged ---- PublicSources($) -
<br />9
<br />(O n -
<br />Private Sources $ Owner Description (Insurance
<br />(/ je_�. Description
<br />Non
<br />(Local, rrederap Recove....
<br />a. Actual Amount
<br />b Projected Amount
<br />4. Jobs of Jobs
<br />5. Greenspace Parks Trails Other (specify)
<br />...------ ._....... ...... ..... ._, ..,,........ ....
<br />Development .... -- _............... . --- ..... _ ,- I .,.....,,.....-,
<br />a Permanent created
<br />a Created
<br />Is Temporary created 1
<br />p Y.
<br />b Retained
<br />., .... ..
<br />c. Retained
<br />..... m. ...
<br />c. Projected ..
<br />.....�
<br />a...Projected
<br />1 ._ .,.,,
<br />...., .......__ ................... .............. ...
<br />d Total Acres/Miles
<br />6. Business: #!Type # of Businesses
<br />Commercial Industrial Mixed Use Description
<br />a Created
<br />----------------
<br />b. Retained
<br />c Projected
<br />7. Housing Units: #!Type # of Housing Units
<br />..
<br />Single -Family Multi -Family Senior -Living Apartments
<br />.. . .... . ....... _ .......-..... ,...,
<br />a. Created
<br />,. ,
<br />b. Retained
<br />.-.- ..... .
<br />'..
<br />c Projected
<br />........,......BuildiReuseterials...-.._._
<br />,...
<br />� 8, Green Reuse) Sustamability Building/
<br />AlteEneive/Low,.,..
<br />enable
<br />in .-.-.-.- _.._._.._. .................. .... �..
<br />Other (specify)
<br />Dave
<br />Energy Development ,,,,,,,,,, .......................-
<br />Mark all fields that apply
<br />......... ............. , . __....... ..............,..-,....... -- ........... __.... ..
<br />9. Assessed Value and Taxes Assessed Property Valuation ($) Assessed Property Taxes ($)
<br />... ,............... ..... ..........................
<br />a Pre -Redevelopment Total
<br />--........... —......... _.._.._...,.............................. .. ................ -----
<br />.. .........
<br />b Current Total
<br />... ..... ......... _____........... _ ....,.,..............AA .,� ,.,.,.,,,
<br />a Projected Total
<br />-- ............. .. m
<br />s[nauam the a of brownfw ee ..�.
<br />E ens in the ..nysiansd _—...-.� �. .„_ ,...
<br />action
<br />10. Community Information (Govt. officials only)
<br />Does the community maintain a brownfrekt im emory?
<br />,,...,.......Pe _.....,.. ,..�.� rfJame
<br />......� _.-_-._._--_.., . .............,,........... .......... ....------------ .-.
<br />. i`YSWia
<br />.. . , ---- ........
<br />Urggnnucalnrn
<br />------.-.. ......... .. ...................� .
<br />!.Phone Number
<br />11. Respondent Information
<br />.._ ,_
<br />EmeO
<br />....... .................... ---- ,,,,,,,,, ...A ... ...... - ---...........,_..-.
<br />.;Date Carnpleted
<br />Return this form to:
<br />INDIANA BROVINFIELDS PROGRAM
<br />100 N Senate Avenue, Room 1275
<br />Indianapolis, IN 46204
<br />Phone: (317) 234-9764 Fax: (317) 234-1338
<br />Or email to: R01FAtry9y j, jri, .4V
<br />Rev Dec 2016
<br />
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