Laserfiche WebLink
STATEMENT OF BENEFITS <br />REAL ESTATE IMPROVEMENTS <br />State Forth 51767 (R2 / 1 -07) <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 rehabilitation of real estate improvements (IC 6- 1.1- 12.1 -4) <br />❑ Eligible vacant building (tC 61.1 - 12.1 4.8) <br />20_ PAY 20_ <br />L.FDRM SB -1 I Real Properly <br />INSTRUCTIONS: <br />1. This statement must be submitted to the body designating the Economic Revitalization Area prior to the public hearing Nthe designating body requires <br />information from the applicant in making its decision about whether to designate an Economic RevitaUzationArea, 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 to 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 indiction of the redevelopment or rehabilitation, <br />BEFORE deduction maybe approved. <br />3. To obtain a deduction, application Form 322 ERA/RE or Form 322 ERAIVBD, Mrichever is applicable, must be Ned with the County Auditor by tha 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- 1/Real Property annually to the application to <br />show compliance with the Statement of Benefits. [IC 6- 1.142.1- 5.1(b) and IC 6- 1.1- 12.1 - 5.36)] <br />5. The schedules established under IC 6- 1.1- 12.14(d) for rehabilitated property and under /C 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 of benefits riled before <br />July 1, 2000. • <br />INFORMATION I TAXPAYER <br />Name of taxpayer <br />Robe ed—*uj ko <br />r4- ,Aq ,in Lifle(` <br />Address of taxpayer (number and street, city, state, and ZlPcede) <br />)23K N. 19-44!1 SE 42-lLy/q SOJA t3end IN ��G /7(/ina(i. %OZO <br />Name of wntact person Telephone n bar <br />4ZobCrt (eosSU /y -S- -95y� <br />E -mail address <br />rkozzle,- Ad, edq <br />SECTION <br />Name of d/etsignating body /� <br />0 <br />Resolution number <br />041 Mc3" `G CIA C/ ( <br />Location of property <br />o W 5 P-,-k- S- Sbut'i, 13 •I f q6 (0 (7 <br />Coun fY <br />S-L- u; wk <br />DLGF taxing district number <br />Description of real property improvements, rredevelopme I, or rhabii}Iitation (use additional sheets %necessary) <br />Ccn51`'MUCtr 2n Gf 3/ 1�!l.`l` <1Wt((r 0.1 a- rcsetF VaCQ /o <br />Estimated start date (month, day, year) <br />O5'2C'--zo/ <br />/k( rim rrp /rM�-nitll� <br />4 th' le.tr) Z Yc.• 415 /� rYCMi 3 CFtro. <br />Estimated date <br />J t 4N h'krt�adl �Se�/cl Z i/a re/ v il'o� f Fret <br />completion (month, day, yead <br />Current number Salaries Number retained Salaries Numberadditional Salaries <br />iF <br />SECTION r TOTAL COST AND VALUE OF •••. . P20JECT <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 />O <br />D <br />Plus estimated values of proposed project <br />3 d e O <br />Less. values of -any property being replaced <br />O <br />L <br />Net estimated values upon completion of project <br />33� pos, <br />a'i , 56cr7 <br />• • r . • • <br />• , <br />Estimated solid waste converted (pounds) N 1 <br />Estimated <br />hazardous waste converted (pounds) <br />Other benefits <br />SECTION C <br />TAXPAYER CERTIFICATION <br />I hereby certify that the representations in this statement are true. <br />Signature of authorizeepre native <br />X7 V, %a <br />Title <br />Date signed (month, day, year) <br />0,l,,`- G7 -2r�i <br />Page 1 of 2 <br />