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o ~ f ~~; STATEMENT OF BENEFITS <br />( ~~'~"yy REAL ESTATE IMPROVEMENTS <br />~, l State Form 51767 (R2 / 1-07} <br />~~_~'~~ Prescribed by the Department of Loca{ Government Finance <br />This statement is being completed for real property that qualifies under the following Indiana Code (check aye 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 />20_ PAY 20_ <br />FORM SB,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 i(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 fo 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.) must be obtained prior to initiation of the redevelopment or rehabilitation, <br />BEFORE a deduction maybe approved. <br />3. To obtain a deduction, application Form 322 ERA/RE or Form 322 ERA/VBD, Whichever is applicable, must be filed with the County Auditor by the later <br />of: (i) 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 tc <br />show compliance with the Statement of Benefits. (IC 6-1.1-12.1-5.1(b) and !C 6-1.1-12.1-5.3(j)j <br />5. The schedules established under /C &-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 o(6enefits filed before <br />July 1, 2000. <br />~ •- • <br />Name of taxpay <br />er <br />` <br />~~c~tc,r~d S c~ncj /1.1ici~'. ~--_ ;~G~>r <br />Address of taxpayer (number and street, city, state, and ZIP code) <br />5H33~t' <br />? 5 <br />C <br />V ~C <br />~ <br />d <br />, <br />- <br />~ <br />, <br />~~ <br />Name of contact person Telephone number <br />` <br />'' <br />~ <br />~ E-mail address <br />Srci~~ <br />~ c~ <br />~ e~rt rc~ <br />d.~r 5'4-d b l-~7U 5 ' ci-tTC~d~Qr : -m~;~,,•om ~~ <br /> <br />Name of designating body <br />Resolution number <br />JJ~~ n <br />'e tl1 MO r C v n~ 1 •~ •Y~ C I f t~ ~C/i'r'1 Q Q n(~ <br />Location of property County DLGF taxing district number <br />AA <br />~G~{Q Lir'YtP .y- /: ~ <br />SGtr1t ~()S? <br />Description of real property improvements, redevelopment, or rehabilitation (use additional sheets if necessary) Estimated start date (month, day, year) <br />A,,~ -,T Uo <br />Estimated completion date (month, day, year) <br />tM n ~ UU <br />• . r . . -.•. . •. <br />Current number Salaries Number retained Salaries Number additional Salaries <br /> <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 <br />Plus estimated values of proposed project <br />Less values of any property being replaced <br />Net estimated values upon completion of project <br /> <br /> <br />Estimated solid waste converted (pounds) Estimated hazardous waste converted o <br />Gther benetit5 ~ ~~ ~ ~ ~~ Rf. =_~r., ~ ' <br />t <br />~vt - ? zoos <br /> <br /> <br /> <br />I hereby certify that the representations in this statement are true. <br />Signature of authorized representative Title Date signed (month, day, year) <br />Page 1 of 2 <br />