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20_, PAY 20_ <br />4~Q "'~°~. STATEMENT OF BENEFITS <br />p~$:~:.. _< `~~ REAL ESTATE IMPROVEMENTS _ - FORM se-1 !Real Property <br />_~' State Form 51767 (R2 / 1-07) <br />~'~ Prescribed by the Department of Local Government Finance <br />Feu <br />This statement is being completed for real property that qualifies under the following Indiana Code (check one box}: <br />^ Redevelopment or rehabilitation of real estate improvements (IC 6-1.1-12.1-4) . <br />^ Eligible vacant building (IC 6-1.1-12.1-4.8) <br />INSTRUCTIONS: <br />1. This statement must be suantt tnemakine ~s de~ston abo ~ whether to designaferanrEconom~ Revr'tali a~onlAreaa Othertvt'se this startement must be s <br />information from the appltc 9 . <br />submitted to the designating body BEFORE the redevelopment or rehabilitation of real property for which the person wishes to claim a deductron. <br />"Projects" planned or committed to after July 1, 1987, and areas designated after July 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.J must be obtained prior to initiation of the redevelopment or rehabilitation, <br />BEFORE a deduction maybe approved. <br />3. To obtain a d~d~~ t~ nthirtpl t 30r da s after the notice of addition to ass d va~af'on or new assessment is mailed totthehroperty owner at ~hetaddress <br />of.' (1) May () Y ( ) Y p <br />shown on the records of the township assessor. <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 o <br />show compliance with the Statement of Benefrts. (IC 6-1.1-12.1-5.1(b) and IC 6-1.1-12.1-5.3Q)] <br />5 of benefits approved ton o~after July 1, 2000. The schedules effecte p~ortto J ay f x2000, shat! continue(to apply to a statementaofpbenefitsy(ledibefore <br />July 1, 2000. <br />Name of taxpayer <br />Heraeus Kulzer, Inc. <br />Address of taxpayer (number and street, city, state, and ZJPcode) <br />4315 S. Lafa ette BIVd. Telephone number E-mail address <br />Name of contact person bbOlka20l <br />Bernie Bolka (574) 299.6621- _ . <br />• Resolution number <br />Name of designating body - <br />County DLGF taxing district number <br />Location of property <br />4315 S. Lafayette Blvd. Saint Joseph <br />Estimated start date (month, day, yeah <br />Description of real property improvements, redevelopment, or rehabilitation (use additional sheets if necessary) 05/01 /2008 <br />Remodel and create offices for corporate headquarters relocation from out of state. Essmatea completion date (mono,. day, year) <br />09/15/2008 <br />Current number Salaries Number retained <br />61.00 $2,537,922.00 61.00 <br />NOTE: Pursuant to IC 6-1.1-12.1-5.1 (d) (2) the COST of the property <br />is confidential. <br />Current values <br />Plus estimated values of proposed project <br />Less values of any property being replaced <br />Net estimated values upon completion of project <br />Salaries Number additional Salaries <br />X2.537,922.00 35.00 $2,9; <br />REAL ESTATE IMPf20VEMENTS <br />COST ASSESSED VALUE <br />4.1 <br />Estimated solid waste converted (pounds) <br />Other benefits <br />I hereby,certify that ~ representations in this statement are true. <br />Estimated hazardous waste converted (pounds) <br />Fii~t~ i~ ~i°C~t'~ ~~~i~e <br />~;A~ 1 9 20G8 <br />JwHN VOORDE <br />CITY CLERK, S0. BERD, IN. <br />Signature o e ntative Title <br />. Page 1 of 2 <br />Date si ned ( nth,.day, year). <br />~~f~~~ <br />