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A-- <br /> 1 <br /> /Is seP „ <br /> 49..4'...14 STATEMENT OF BENEFITS L_ Z,r�S <br /> 20 PAY 20 <br /> , •' t; REAL ESTATE IMPROVEMENTS L,i <br /> •+ Stale Form 51767(R412.15) r.. �C FORM SBA 1 Real Property <br /> Prescribed by the Department of Local Government Finance <br /> PRIVACY NOTICE <br /> This statement is being completed for real property that qualifies under the following Indiana Cede(check one box): The cost end any spec-14 individual's <br /> Redevelopment or rehabilitation of real estate improvements(IC 6-1.1-12.1-4) salary Wathe C Is s potai roc rd the <br /> balance of U,a CMG.It public record <br /> Residentially distressed area(IC 6-1,1-12.1.4.1) 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 poor 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 fho person wishes to claim a deduction. <br /> 'Projects'planned or committed to after July 1, f987.and areas designated after July 1. 1987,require a STATEMENT OF BENEFITS. (1C 6.1.1-12,I) <br /> 2 Approval of the designating body(City Council, Town Board,County Council,etc.)must be obtained prior to Initiation of the redeveiopment or <br /> rehabilitation,BEFORE a deduction may be approved. <br /> 3. To obtain a deduction,a Form 322/RE must be filed with the County Auditor before May 10 in the year in which the addition to assessed valuation is <br /> made or not later than thirty(30)days after the assessment notice is mailed to the property owner if it 1s'as mailed after April 10. If the property owner <br /> misses the May 10 deadline In the fnrtlal year of occupation,he can apply behveen March 1 and May 10 0l a subsequent year. <br /> 4, Property owners whose Statement of Benefits was approved after June 30, 1991.must attach a Form CF•11Real Property annually to the application to <br /> show compliarlte with the Statement of Benefits. (IC 6.1.1.12.1-5.1(b)and IC 6-1,1-12.1-5.30)j, <br /> 5. The schedules established under 1C 6.1.1-12.1-4(d)for rehabilitated property apply to any economic revitalization areas designated after June 30,2000, <br /> unless an alternative deduction schedule Is adopted by the designating body(iG 6-1.1-12.1-17). The schedules effective prior to July 1.2000.shall <br /> continue to apply to economic revrtalzation areas designated before July 1,2000. <br /> SECTION 1 _. • •• - TAXPAYER INFORMATION'-: _ .......... r . <br /> Urine oI laxpayer <br /> Tho Toe or at Wait-region Square LLC <br /> Address or taxpayer(numbw 80d street,dily slake.arid ZIP code) <br /> 6.44 47th Avenue,Sort Fba.Long Island City,NY 11101 <br /> Nzme ar contact person Telephone nuretor E-nisi address <br /> Liti ly MgeSados (1&788-5155 thelawcra MVshtng:onsquare:coignailcarn <br /> •i.. SECTION 2 L'OCATiONAND DESCRIP,,TION.OF PROPOSED.PROJECT =:5;'"' ;:':' <br /> Name of designating body Rese when number <br /> South tiered Common Coorx.tI <br /> Location o property County-- DLGF taxing drstdct number <br /> 211 W.Wasringbn St St Josepl, <br /> Dascepbon or real property improyerrentsTiedevvelopmenl.or rehabi;iiabon ride adeSorrel cheats fl re-cesssry) Estimated star data(month.day year) <br /> 09/9115 <br /> The btt:drrg'e age aid slgrircenl de'arred mein;ens ice Lsiuis hays R•ale'.'re rw.ilrg o5sotescari ashore a complete medrmVatLos or Miffing%1drx estimated corrdCe0on data(marl dry year) <br /> 01101/17 <br /> - SECTION 3.=t'= ?'`iE§TIMATEOFEMP.LOYEESANDSA`�ARIESASRESULT:OrPRQP,08E0:PROJECTS=w°y°.'c_:.�..-� s <br /> Current number Salado, NU'nbu rd►ined Salaries Number ad(A'onsl Salaries <br /> 0 n 20 5200 <br /> _SECTION 4:-: . . - tESTItt1ATE0 TOTAL COST%1ND VAW E'OF PROPQSED PROJECT'; ,, • ;.•,• <br /> REAL ESTATE IMPROVEMENTS <br /> COST ASSESSED V ALUE__ <br /> Current values 78, 8 <br /> Plus estimated values of proposed project J 202971 <br /> Less values of any property being replaced <br /> -- <br /> Net estimated values upon comptetion of pi•ect <br /> SECTION 5 ..WASTE CONVERTED:AND'GTHER.BENEFITS.PROMISEb:BY�7NE TAXPAYER `.'si=z `.`-•. -` '. <br /> Estimated solid waste converted(pounds) ._ Estimated hazardous waste converted(pounds) <br /> Other benefits <br /> ( <br /> SECTION 6 - • TAXPAYER CERTIFICATION. <br /> • I hereby certify that the representations in this statement are true. <br /> S..- :' •o ;vino/tied reprolen.T T.1e Date signed(month,day year) <br /> S, ✓. _ 6'.an 5e' 5118115 <br /> Page 1 of 2 <br />