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l�11l: <br />STATEMENT OF BENEFITS <br />REAL ESTATE IMPROVEMENTS <br />State Form 51767 (R211 -07) <br />Prescribed by the Department of Local Government Finance <br />Thi atement is being completed for real propertylhat 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 />20_ PAY 20_ <br />FORM SB -1 I Real Property <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 Revitalization Area. 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 initiation of the redevelopment or rehabilitation, <br />BEFORE a deduction maybe approved. <br />3. To obtain a deduction, application Form 322 ERA/RE or Form 322 ERANBD, Whichever is applicable, must be filed with the County Auditor by the 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- 1.1- 12.1- 5.1(b) and IC 6 -1.1- 12.1 - 5.36)] <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 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 filed before <br />July 1, 2000. <br />)ir <br />Page 1 of 2 <br />L <br />SECTION •- <br />Name of taxpayer <br />a <br />Address of taxpayer (number and street, city, state, andSUP code) p , (,f <br />— Giv 1�� <br />Name of contact pe on Telephone number <br />�Ovrr- <br />E //-mail <br />efi n ° s<2Jyi <br />., <br />SECTION 2 LOCATION AND DESCRIPTION OF PROPOSED PROJECT <br />Name of designating body <br />Resolution number <br />Location of property <br />County <br />OLGF toxin district number <br />b y <br />Description of real property improvements, redevelopment, or rehabilil tion (use additional sheets ifne essary) <br />/'✓i'slIC, -, 1 <br />at ated start date (month, day, year) <br />I5- <br />x LL—S> �'"t-�-� <br />Estimat complefion dale (month, day, year) <br />AJ a, P� <br />a��� <br />SECTION 3 ESTIMATE OF EMPLOYEES AND SALARIES AS RESULT OF PROPOSED PROJECT <br />Current number Salaries Number retained Salaries Number additional Salaries <br />SECTION 4 ESTIMATED TOTAL COST AND VALUE <br />OF PROPOSED PROJECT <br />NOTE: Pursuant to IC 6 -1.1- 12.1 -5.1 (d) (2) the COST of the property <br />REAL ESTATE IMPROVEMENTS <br />COST <br />ASSESSED VALUE <br />is confidential. <br />Current values <br />Plus estimated values of proposed project <br />O <br />Less values of any property being replaced <br />Net estimated values upon completion of project <br />O <br />SECTION 5 WASTE CONVERTED AND OTHER BENEFITS PROMISED <br />BY THE TAXPAYER <br />Estimated solid waste converted (pounds) <br />Estimated haz us was i oo ted^ <br />Other benefits <br />� ZQ1� <br />LrLLER,-;-:�V1 <br />Joi <br />N (SEND, IN <br />SECTION - <br />I hereby Dart' that the r Santa Pris in this statement are true. <br />Signature of orized rapt ive <br />Title <br />Date ignetl (man , da y rJ _ <br />)ir <br />Page 1 of 2 <br />L <br />