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<` f" STATEMENT OF BENEFITS <br />REAL ESTATE IMPROVEMENTS <br />State Form 51767 (R2 / 1 -07) <br />Prescribed by the Department of Local Government Finance <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 />21 Eligible vacant building (IC 6- 1.1- 12.1 -4.8) <br />20_ PAY 20_ <br />FORM SS -1 1 Real Property <br />INSTRUCTIONS: <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 <br />submitted to the designating body BEFORE the redevelopment or rehabilitation of real property for which the person wishes to claim a deduction. <br />"Projects" planned or committed to after July 1, 1987, and areas designated after July 1, 1987, require a STATEMENT OF BENEFITS. (!C 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 />BEFORE a deduction may be approved. <br />3. To obtain a deduction, application Form 322 ERA/RE or Form 322 ERANBD, Whichever is applicable, must be filed with the County Auditor by the later <br />of: (1) May 10; or (2) thirty (30) days after the notice of addition to assessed valuation or new assessment is mailed to the property owner at the address <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 -I/Real Property annually to the application to <br />show compliance with the Statement of Benefits. (IC 6 -1.1- 12.1- 5.1(b) and IC 6 -1.1- 12.1 - 5.36)) <br />5. The schedules established under IC 6- 1.1- 12.1 -4(d) for rehabilitated property and under IC 6 -1.1 -12.1- 4.8(1) for vacant buildings apply to any statement <br />of benefits approved on or after July 1. 2000. The schedules effective prior to July 1, 2000, shall continue to apply to a statement of benefits filed before <br />July 1, 2000. <br />INFORMATION <br />Name of taxpayer <br />River Rock Incorporated <br />Address of taxpayer (number and street, city. state, and ZIP code) <br />1433 Northside Blvd <br />Name of contact person Telephone number <br />Email address <br />David Morgan (574) 234 -2060 <br />david(a�force5media.com <br />Name of designating body <br />Resolution number <br />Location of property County <br />DLGF taxing district number <br />1433 Northside Blvd Saint Joseph' <br />Kwe <br />Description of real property improvements, redevelopment, or rehabilitation (use additional sheets if necessary) <br />Estimated start date (month, day, year) <br />05/01/2008 <br />Estimated completion data (month, day, year) <br />1/2010 <br />Current number Salaries Number retained Salaries Number additional Salaries <br />8.00 $400,000.00 8.00 $400,000.00 2.00 $80,000.00 <br />NOTE: Pursuant to IC 6 -1.1- 12.1 -5.1 (d) (2) the COST of the property REAL ESTATE IMPROVEMENTS <br />is confidential. COST ASSESSED VALUE <br />Current values 156.000.00 165.000.00 <br />Plus estimated values of proposed project 78.000.00 78.000.00 <br />Less values of any property being replaced <br />Net estimated values upon completion of project <br />250.000.00 <br />Estimated solid waste converted (pounds) 0.00 Estimated hazardous waste r <br />Other benefits �i n !>�; , <br />E2 008 <br />CITY CLc"K, SO, E N7, )N. <br />TAXPAYER CERTIFICATION <br />SECTION 6 <br />h reby certify that the representations in this statement are true. <br />Sign thorized•rgixe a five <br />l <br />Ttlet <br />lt�(. <br />Date signerdd month jyear) <br />7 +' <br />Qi rage I or z <br />