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" STATEMENT OF BENEFITS <br />c VACANT BUILDING DEDUCTION <br />State Form 55182 (R / 2 -14) <br />® Prescribed by the Department of Loral Government <br />This statement is being completed for real property that qualifies as <br />IC 61.1 - 12.1 - 1(17). <br />Filed it" ° ;f <br />MAR J 2014 <br />1nce .- . ....I <br />20_ PAY 20_ <br />FORM SB -1 / Vgl <br />PRIVACY NOTICE <br />The cast and any specific individual's <br />salary informatbn is mnfrdenbal; the <br />balance of the filing is public record <br />per IC 6-1.1- 12.1 -5.1 (c) and (d). <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 <br />requires information from the applicant in making its decision about whether to designate an Economic Revitalization Area. Otherwise, this statement <br />must be submitted to the designating body BEFORE the occupation of the eligible vacant building for which the person wishes to claim a deduction. <br />2. To obtain a vacant building deduction, a Form 322(VBD must be filed with the county auditor before May 10 in the year in which the property owner <br />or his tenant occupies the vacant building or not later than thirty (30) days after the assessment notice is mailed to the property owner if it was <br />mailed afterApril 10. If the property owner misses the May 10 deadline in the initial year of occupation, he can apply between March land May 10 <br />of subsequent year <br />3. A pr tthe approved Form SB -1NBD. The Form CFINBD must also be updated each year innwh ch the deduction is applicable. D to show compliance <br />SECTION 1 TAXPAYER INFORMAT10N <br />Name of taxpayer f\ 1 r LL <br />Address oftaxpayer (nmberand street, city4 state, and ZIP code) <br />Name of contact person :tTe phone number <br />V;a 4) 9bSr -3CGo <br />E -mail address <br />SECTION 2 LOCATION AND DESCRIPTION OF PROPOSED PROJECT <br />Name of designating body <br />Resolution number <br />Location of property County <br />-Z(I5 w. �J�t� A,► St S* Jo <br />Di taxing district number <br />�� <br />Esgmatetl occupancy tlate (month, day, year) <br />15'— ZO <br />Descripbon of eligible vacant building that the property owner or tenant will occupy (use addihana/ sheets H saary). <br />1— 14 <br />O�S�r,�cy+-t0 ° thCJt <br />da <br />th, Z'44 y, year) <br />Estimated dal � � <br />Current number Salaries <br />1l 5_0 C) <br />ber retained Salaries Number additional Salarie <br />uo K Z '! c) k <br />Lm S i <br />SECTION ESTIMATED <br />TOTAL COST AND VALUE OF PROPOSED PROJECT <br />REAL ESTATE IMPROVEMENTS <br />COST <br />ASSESSED VALUE <br />Current values <br />i0 K <br />Plus estimated values of proposed project <br />Less values of any property being replaced <br />Net estimated values upon completion of project <br />SECTION EFFORTS SELL •- <br />Described efforts oy the owner or previous owner to sell, lease, or rent the building during period of vacancy <br />P «J7e�s aw..ac "A%A%V- rcicl�Y Ilc+c� + 4-or <br />'I'�r'C YC�rS g•.a J�Crew�SG <br />Show amount for which the building was offered for sale, lease, or rem during period of vacancy. Z. S,Q <br />360 K <br />or <br />List any other benefits repainting from the occupancy of the eligible vacant building <br />MOO kc_ '►c �u`�G1ri6NL{.�Y/ <br />�(gxry fo '� 56ve,r..f, 1�prs •10Y�Cw'�T "D -' <br />(:o3A.c_i-LS a.J'.aS SC_C.0 r.4y 04 �iL proQer-kr.r •"r%�T P1°p!/+ Y Q.% it <br />gZati ;, p�o�:�: �:5� .,J��y 10 k �e,+s p�a���s +G Ae- L J S�A 4s 6*-(k• <br />5 y <br />TAXPAYER CERTIFICATION <br />SECTION . <br />I hereby certify that the representations in this statement are true. <br />Signature ofa odzed re esenta ` <br />Title <br />Date sili (month, �d year) <br />- t Y <br />Page 1 of 2 <br />/ <br />