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0 ® STATEMENT OF BENEFITS <br />REAL ESTATE IMPROVEMENTS <br />State Form 51767 IN 12 -13) <br />Prescribed by the Department or Local Government Finance <br />This statement is being completed for real properly, that qualifies under the fogowing Indiana Code (check one box): <br />❑ Redevelopment or rehabilitation of real estate improvements (IC 6.1.1- 12.14) <br />❑ Residentially distressed area (IC 6- 1.1- 12.14.1) <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 Revital zationArea. Otherwise this statement In at submitted to the designating body BEFORE the redevelopment orrehabilitation of real property for which the person wishes r, claim a deduction. <br />2 Projects "planned or commttetl fo afterJuy 1, 1987, and areas designated afterJUry 1, 1987, require a STATEMENT OF BENEFITS: (IC S-1.1 -12.1) <br />Approval of the designating body (City Council, Town Board, County Council, etc.) must be obtained priorto initiation of the redevelopment or <br />rehabilitation, BEFORE a deduction may be approved. <br />3. To obtain a deduction, a Form 3221RE must be filed with the County Auditor before May 10 in the year in which the addiction to assessed valuation is <br />made ornot laterthan thirty (30) days afterthe assessment notice Is mailed to the property ownerif it was mailed afterApol 10. If the property owner <br />misses the May 10 deadline in the initial yearofoccupation, he can apply between March 1 and May 10 of a subsequent year. <br />4. Property owners whose Statement of Benefits was approved after June 30, 1991, must attach a Form CF- 1/Real Properly annually to the application to <br />show compliance with the Statement of Benefits. [lC &I.1- 12.1- 5.l(b) and IC <br />5, The schedules established under IC 6- 1.1- 12.1.4(4) for rehabilitated property apply to any economic revitalization areas designated after June 30, 2000, <br />unless an afterriahYe deduction schedule is adopted by the designating body (IC 6-1.1- 12.1 -17). The schedules effective prior to July 1, 2000, shall <br />continue to apply to economic revitalization areas designated before July 1. 2000. <br />REAL ESTATE IMPROVEMENTS <br />T <br />Current values <br />ASSESSED VALUE <br />$ws00 <br />Plus estimated values of proposed project 6 <br />g37 <br />Less values of an roe being replaced 0 <br />0 <br />Net estimated values upon completion of pro act $4,936.278 <br />Estimated solid waste converted (pounds) <br />Other benefits <br />I hereby certify that the representations in this statement are true. <br />Estimated hazardous waste <br />i 3 2014 <br />JOHN \t' -e)'JE <br />CITY CLERK, SOUTH SEND, IN <br />epO�reff�prv.�represenlawe pw,'`:a...:.A.,,�,,.,.. Title <br />1lll fill �6-�l �1 ^°'� •� Date signed fmonm, day,, yeah <br />Business Process Manager 10/10/2014 <br />Page 1 of 2 <br />