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20 PAY 20� <br />STATEMENT OF SE14EFITS <br />REAL ESTATE IMPROVEMENTS <br />FORtvi SB -1 /Real Property <br />' State Form 51767 (R2 I 1 -07) <br />' z Prescribed by the Department of Local Government Finance <br />e,e <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 />❑ Eligible vacant building (IC 6 -1.1- 12.1 -4.8) <br />INSTRUCTIONS: <br />1. This statement must be submitted to the <br />information from the applicant in making body <br />s deison about designating the whether o designate an Economic rRevitalizationl Area. nOtherwise this statement must be <br />s <br />submitted to the designating body BEFORE the redevelopment or rehabilitation of real property for which the person wishes to claim a deduction. <br />after July 1, 1987, and areas designated after July 1, 1987, require a STATEMENT OF BENEFITS. (IC 6 -1.1 -12.1) <br />"Projects" planned or committed to a Approval of the designating body (City Council, Town Board, County Council, etc.) must be obtained prior to initiation of the redevelopment or rehabilitation, <br />2. App <br />BEFORE a deduction may be approved. or Form 322 3 of: (1) May deduction, do thirty application <br />days after the notice of addition to a se sed valuation vor new assessment must s mailed to the property owner at the address <br />shown on the records of the township assessor. lication to <br />4. Property owners whose Statement o f Benefits was approved after June 30, 1991, must attach a Form CF -1 /Real Property annually to the app <br />show compliance with the Statement of Benefits. (IC 6- 1.1- 12.1- 5.1(b) and IC 6 -1.1- 12.1- 5.3Q)J 1 to an statement <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 app y y <br />e to apply to a statement of benefits filed before <br />of benefits approved on or after July 1, 2000. The schedules effective prior to July 1, 2000, shall continu <br />July 1, 2000. <br />Name of taxpayer <br />Address of taxpayer LnUmber and street, city state, and zip code) <br />(J q ;*q sT <br />Name of contact person ^ y �C <br />F1"IL 'Q f�),,U6,J Q) <br />Name of <br />a A S L e. -,u/ Cf e-4 <br />Telephone number <br />.ocation of property <br />IDlq N� i pr QAA�`�� AVM S/3. T <br />5escription of real property! provements, redevelopment, or rehabilitauon I a <br />W241 MM <br />Current number Salaries Number retained <br />County <br />0 <br />Dnal sheets if necessary) <br />A 2- ca. S Ar2J� <br />NOTE: Pursuant to IC 6 1.1- 12.1 -5.1 (d) (2) the COST of the property <br />is confidential. <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 />Estimated solid waste converted (pounds) <br />Other benefits <br />hereby certify that the representatirs in this statement are true. <br />Salaries <br />Ll 0 V <br />E -mail address I� <br />D6 I. E dd rv�UC�✓CG'3f0� rFOnt� <br />Resolution number <br />DLGF taxing district number <br />PQ r 'FG , <br />Estimated start date (month, day, year) <br />QCT lj-f4 - f),? <br />Estimated.00mpletion date (month, day, year) <br />�ukf <br />Number additional I Salaries <br />REAL ESTATE IMPROVEMENTS <br />COST ASSESSED VALUE <br />Estimated hazardous waste <br />FilEg.1-4,14 d In CI�i�'��ti�t <br />1 8 2008 <br />OUDE1`J, M. <br />CM CLEi3K, <br />inpt re of author' d repr entativ <br />t 4 Et tilt , 7< <br />Page 1 of 2 <br />signed (month, day, year) <br />161- °'? — <br />