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�`"" �� STATEMENT OF BENEFITS
<br /> / 20_PAY 20_
<br /> REAL ESTATE IMPROVEMENTS
<br /> \ ' State Form 51767(R2/1-07) FORM SB-1 I Real Property
<br /> `'` -'•" Prescribed by the Department of Local Government Finance E/�`(/�"��""®""eyg
<br /> �aTs Filed ■! Clerk's f
<br /> This statement is being completed for real property that qualifies under the following Indiana Code(check o e 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) 04 1
<br /> INSTRUCTIONS: OCT 1�tg .
<br /> 1. This statement must be submitted to the body designating the Economic Revitalization Area prior to the.ublic -. ,/. . -•. requires
<br /> information from the applicant in making its decision about whether to designate an Economic Revitaliz.do •1.7 t`_ ent must b:,
<br /> submitted to the designating body BEFORE the redevelopment or rehabilitation of real property for whip h the Pere 'Arealaffliat■.:. 4N
<br /> "Projects"planned or committed to after July 1, 1987,and areas designated after July 1, 1987,require a • • , a- .. - )
<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-1/Real Property annually to the application to
<br /> show compliance with the Statement of Benefits. jIC 6-1.1-12.1-5.1(b)and IC 6-1.1-12.1-5.3(j)J
<br /> 5. The schedules established under 1C 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 /> SECTION 1 " TAXPAYER INFORMATION
<br /> Name of taxpa
<br /> Address f xpayer(number and street,city,state,a'd ZIP ode) 9 474 jL
<br /> Name conta• -:son -' / Telephone number E-mail address
<br /> J a,� p
<br /> SECTION 2 LOCATION AND DESCRIPTION OF PROPOSED PROJECT
<br /> Name of:-s•nating body Resolution number
<br /> Ofreik Cat) 6. a v,tie,/ ' a. ci Imo,
<br /> Location of property /
<br /> //� ��{j/0,40 /� ,S DLGF taxing district number
<br /> V 3 V ✓AVIce i Vii: Coun •:3o4/t
<br /> Description of real propertyim rovements,redevelo ment,or rehabilitation(use additional sheet if necessary) / IN Estimated start date(month,day,year)
<br /> ak- , i, f4 3'"f Ocrft 6 <oke. aN Y'A'CAAv)L Ov N U4I
<br /> AA.' r��sf'r////M • O tX-a76O•SkTi 7C �..4542060.X., �.1 ea _ .4 Z4rpft-'5C/ i� Estimated m
<br /> 1/��' 404444,10: f ; g f / completion date(month,day,year)
<br /> •SECTION 3 ESTIMATE OF EMPLOYEES AND SALARIES AS RESULT OF PROPOSED PROJECT
<br /> Current number Salaries Number retained Salaries Number additional Salaries
<br /> SECTION 4 t, EST ,y, 'D TOTAL COST AND VALUE OF PROPOSED 71.4,JECT
<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 SO t$o
<br /> Plus estimated values of proposed project - Vs0,000 S7so,00
<br /> Less values of any property being replaced
<br /> Net estimated values upon completion of project vl.5-50 0l+o -'.S 0 000
<br /> SECTION 5 WASTE CONVERTED AND OTHER BENEFITS PROMISED BY THE TAXPAYER
<br /> Estimated solid waste converted(pounds)
<br /> Estimated hazardous waste converted(pounds)
<br /> benefits AL. J 1 J d d ,., l .4.4,16.4.4,16.4....tees VKa-45 64,41,;X2
<br /> .
<br /> .e SM. . u t� -1-14�Ry1� ! s/ac �IZCif..p[4 �f x�� /�, /9 OS /ky
<br /> o r
<br /> / 9d!•-✓-2 M.947),40€_.AtAt•47-)44.44.5.
<br /> r /A.444rz, v ex ra y ofer;Ate.a s • i,1- -W
<br /> A-s
<br /> Ce2dege
<br /> 4 kih, arrvartx r/✓N i,✓ CetA,et44 i C.4 c;ee. et /(61 .4...% u./led. -4. Aga v i A /
<br /> ,,z. il e'� c-es •
<br /> SECTION 6 TAXPAYER CERTIFICATION
<br /> I hereby certify that the representations in this st- - ent are true.
<br /> Sign: re of au-orize. :" to•,• `� Title `Date signe (mo th,day,year)
<br /> ' % - I /6 9 /2_
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