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STATEMENT OF BENEFITS <br />Stale Form 27167 (R7/12-01) <br />tY Prescribed by the Department of Local Government Finance <br />.m• <br />FORM <br />INSTRUCTIONS: <br />1. This statement must be submitted to the body designating the economic revitilization area prior to the public hearing if the designating body requires infor- <br />mation 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 1 or research and development equipment, or BEFORE the <br />redevelopment or rehabilitation of real property for which the person wishes to claim a deduction. 'Projects" planned or committed to after July 1, 1987 and <br />areas designated after July 1, 1987 require a STATEMENT OF BENEFITS. (1C 6-1.1 -12.1) <br />2. Approval of the designating body (City Council, Town Board, County Council, etc.) must be obtained prior to initiation of the redevelopment or rehabilitation, <br />or prior to installation of the new manufacturing equipment and I or research and development equipment, BEFORE a deduction may be approved. <br />3. To obtain a deduction, Form 322 ERA, Real Estate Improvements and I or Form 322 ERA I PPME and 1 or 322 ERA 1 PPR & DE, must be freed with the <br />county auditor. With respect to real propperty, Form 322 ERA must be filed by the later of (1) May 10; or (2) thirty (30) days after a notice of increase in real <br />property assessment is received from tha township assessor. Form 322 ERA I PPME and i or 322 ERA PPR & DE must be tiled between March 1 and May <br />15 of the assessment year in which new manufacturing equipment and I or research and development equipment becomes assessable, unless a filing <br />extension has been obtained. A person who obtains a filing extension must 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 annually to show compliance with the Statement <br />of Benefits. (/C 6-1.1- 12.1 -5.6) <br />5. The schedules established under iC 6 -1.1- 12.1 -4(d) and IC 6 -1.1- 12.1 -4.5 (e) effective July 1, 2000 apply to any statement of benefits riled on or after <br />July 1, 2000. <br />The schedules effective prior to July 1, 2000 shall continue to apply to those statement of benefits filed before July 1, 2000. <br />taxpayer <br />IRC,0 <br />of taxpayer (street and number, city, state and ZIP code) <br />�,, II -(-- _ <.0o -t_4 Quo, irk 4&G17 <br />Name of contact p�er on <br />L7f'ZIt4f�l !•tll.CF.2 YPOP0pER1rnQrJS �EtSS 4oMr=S? Iti1G. <br />Telephone number <br />(s�4i z.4 -77.3 <br />K6191 'A I 10 •. •. <br />Resolution number <br />Name of designating body <br />SO,J -n - njg C)l COW -A0Q <f4,cJn1GT (.- <br />Location of pr perty _ County <br />N f 1 gjEG. 32 "r 37 t`� (Z3 E S'7-_ SOSEPI -} <br />Taxing 'district <br />Fit`) T,�htNSF} i i' <br />Description of real property improvements and I or neW manufacturing equipment and I or <br />research and development equipment (use additional sheets !f necessary) <br />ESTIMATED <br />Start Date <br />Completion Date <br />spitz 1 iAL� `06 <br />�(Lo PEIl T`f 1 S t3 �t W-, PE�iE I�°PED t r\]ro 3 Real Estate <br />NM, <br />"A- <br />SJ,j6,c.r— FAMtt.:q p6stDC- rjrlAt_ �h-s , vJH -IGi+ 1AF New Mfg Equipment <br />� -1 EL7 tt?4 Lni G(LF OAt�s, `TtoN OAJC- • R & DE <br />WA- <br />aPir- <br />LP(Lo posF.p <br />Current number Salaries Number retained Salaries <br />Number Num ; er additional Salaries <br />1 V t-t lv''t <br />N /� NA- lvnC <br />NOTE: Pursuant to iC 6 -1.1- 12.1- 5.1(d) (2) the <br />Real Estate Improvements <br />Machinery <br />Research and Development <br />Equipment <br />Cost <br />Assessed Value <br />Cost <br />Assessed Value <br />Cost <br />Assessed Value <br />COST of the property is confidential. <br />Currentvalues PA4*M`r t_ <br />Plus estimated values of proposed project <br />rj i 3S 000 <br />Less values of any property being replaced <br />Net estimated values upon completion of project <br />• . . . • <br />Estimated solid waste converted (pounds) NAr Esti ted h zardouswastetb ve a (poun s) <br />Other benefits: - 2008 <br />NA- 4 -'� 7 <br />,;raft, YCCRDE <br />Ci?Y ct a {, so. ai:NO, tit. <br />• Imam M-7-TIT) <br />I hereby_certify that the re resentations in this statement are true. <br />Signature of authorized representative Title Date signed (month, day, year) <br />1 <br />