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DocuSign Envelope ID: DBF1C726- DE714282- AE01- AD61)i8F646AD <br />r STATEMENT OF BENEFITS 20 PAY 2D_ <br />REAL ESTATE IMPROVEMENTS <br />1 Slate FOM$1767(R3r 147] FORM SB -0 /R9al Properly <br />P Prescribed by the Department of Local Government Finance <br />This statement is being completed for real property that qualifies under the following Indiana Code (chock one box): <br />Redevelopment or rehabilitation of real "tale improvements (IC 6.1.1- 12.14) <br />0 Eligible vacant building (IC 61.1.12.14.8) <br />INSTRUCTIONS: <br />1. This statement must be submitted to the body designating Me Economic Rovllarsalfon Area prior to the public hearing A the de5lgnalms, body roowms <br />inlOnnalion from fhe aPPflcanl in making its deasion about whefher(o tlesigne(e an Economi Revihlizp(ion Ama. Olharvdse Ihas statement n usl ba <br />submitted 10 (ho designating body BEFORE the redevelopment or mhabflashon otreelpropedy for which the person wishes fO claim a da luclfon. <br />Projects - planned Or commilled to after July 1, 1987. andaraesdesgnalada)Nr Jnlyl, 1987. resume a STATEMENT OF BENEFITS. (IC6.1.1 -12.f) <br />2. Approval of the deslgnailrlg body (City COumee TO. SOard, Caunry, Council cle.) must be oNalnedprior toImdab'on m oflhe,adorelOpmant PrmhabilRalion, <br />BEFORE o deduction may be approved To obtain a deduction. threlcopon Form 322 ERA/RE or Form 322 ER"SD, Whfchover is applicable, must be Lied with the CountyAudf(or by he tiler <br />Of (1) May 10; or (2) fhfdy (30) days ether the molder, of addition to assessed velvallon or new assessment Is mailed to the propedy owns, of Iha address <br />shown on the records of the township assessor. <br />4. Property owners whose Statement of Behefils was approved after June 30, 1991, must attach a Farm CF- IlRoal Property annually to the application to <br />show compliance with the Statement 0(Benefils. PC 6.1.1- 11.1.5.1(b) and IC 6- 1.1-1213.30)] <br />5. The schedules established under !C6-f.1-12.1.4(d)fornhabgReledpmparfy and under lC& 1.1.12.1.4.8(1)lorvacant buildings apply to any slalemenf <br />ofbeneMs appromd on Grafter July 1, 2000. The schedules effective pdorfo July 1, 2000- shall continua 10 apply to a statement o)bane(IS yded before <br />Juh, 1. 2000. <br />Page 1 of 2 <br />Name of taxpayer <br />T2P'1 <br />Q'upMeAatlr<S9 <br />olidxWMr(nulnnof ano elROL tih!H' <br />II w_ ,, l <br />N y 0 <br />Name a /vmle4 Wlaon <br />Rlephond <br />;ZI1.1 <br />Tde a�Cer <br />574-Z51.Oj DU <br />aeagmtrg Tway <br />Resoutori mme p, <br />LMJlien pl p�0(wny <br />Lmnty <br />DLGF Memo OeNU number <br />37 N. M. la. yG <br />Sasd !. <br />Deaatlplim of rem plopeny lmprovu ants, mee proem. on liletion f.amorname'rhama <br />frnamsmry) <br />ELmwNtl LOn tlme (mmlh. day. pet <br />9 113 <br />Esw W Na cmge4m aau (mo'vh. am yeatt <br />v Z3 IS <br />Cunenlmlmber Salaries a Nmnppr reraNea <br />SaWlea a a NWnper atlm6prW salaMs <br />f'1 I 315 000 9 <br />,315 UUOi <br />C O <br />NOTE: Pursuant to IC 6-1.142.1- 5.1(d) (2) the COST of the properly <br />REAL ESTATE IMPROVEMENTS <br />is confidential. <br />COST <br />1 ASSESSED VALUE <br />Current values <br />Z O <br />Plus estimated values of proposes project <br />L 53 O <br />Less values of any property being replaced <br />Net estimated values upon completion of project <br />agg f <br />Estimates ssiid waste wnverted (pounds) <br />Estimated haIDrdp se can un <br />Gtho,benoats <br />Fl! <br />