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STATEMENT OF BENEFITS 2p_PAy 20_ <br /> REAL ESTATE IMPROVEMENTS <br /> State Form 51767(8211-07( FORM SB-1 I Real Property <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 rehabllftation of real estate improvements(IC 61.1-12.10 <br /> El Eligible vacant building(IC 6-1.1-12.14.8) <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 orrehabilitation of feat property for which the person wishes to claim a deduction. <br /> 'Projects'planned of committed to after July 1, 1987,and areas designated after July 1, 1987,requlre 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 may be 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.,(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 6G 1.1-12.1-5.1(b)and IC 6-1.1-12.1-5.36)1 <br /> 5. The schedules established under IC 6-1.1-12.14(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,shell continue to apply to a statement of benefils filed before <br /> July 1.2000. <br /> ,+. ,�. :a •fir °. -� l dl'C'1. <br /> Name of taxpayer <br /> Address of taxpayer(number arm street,cit,state,and ZIP cartel <br /> 133`1 a N en N 6G 17 <br /> Name of contact person Telephone number E-mail soure <br /> KCq'(1 °th '5'7'1 3yLf 600 ' hjdeet11'rar)d . ej <br /> Name of designating baby Resdutinn numbor <br /> Location of property County DLGF taxing district number <br /> Description of real property improvements,redevelopment,or rehsbllltation(uso additional sheers if necessary) Estimated start able(month,day,real <br /> Estimated completion dale(month,oey.year) <br /> Current number �Y Salaries Numbor retained Salaries Nond;er additloral Salu'o' <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 3 i i,` 0�' Oov <br /> ° Fax.. ° ° ° ° -° ° �. �;lJ q ..7+� ��' ..w`c> .hit• <br /> r tyP' <br /> Estimated solid waste converted(pounds) Estimated haz rdw:c-r•°='�=r r �ddt(p_�l <br /> Other bene.is le n er S ICG' <br /> a <br /> OCT 31 2013 <br /> JOHN VOORrE <br /> CITY CLERK,SOUTH BFI ND IN <br /> I hereby certify that the representations in this statement are true. <br /> Signature of authorized represenbt TIlle Date signed(month,tlay year) <br /> Page 1 of 2 <br />