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i/ 5(p <br /> ,2<0 •• STATEMENT OF BENEFITS /) <br /> '' REAL ESTATE IMPROVEMENTS e` 20 PAY 2a� <br /> ult� ; <br /> State Form 51787(R4/2.13) FORM 6B-1/Real Property <br /> Prescribed by the Department of Local Government Finance <br /> PRIVACY NOTICE <br /> • <br /> ibis statement Is being completed for real property that qualifies under the following Indiana Code(check one box): The cost and any spoc4e indivdua/s <br /> 0 Redevelopment or rehabilitation of real estate improvements(IC 6-1.1-12.1-4) salary a of n ccnfdangc the <br /> ba`ance of the sling:s publr record <br /> 0 Residentially distressed area(IC 6 1.1-12.1-4.1) pc'IC 6-1.1-12.1-5.1(c)end(d) <br /> INSTRUCTIONS: <br /> 1. This statement must be submitted to the body designating the Economic Revitalization Area poor to the public heating It 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 comnlitted 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 <br /> rehabilitation,BEFORE a deduction may be approved. <br /> 3. Yo obtain a deduction,a Form 322/RE must be tiled 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 aRer the assessment notice Is mailed to the properly owncrif if was mailed alter April 10. if the property owner <br /> misses the May 10 deadline in the Initial year of occupation.he can apply between March 1 and May 10 of a subsequent year. <br /> 4. Property owners whose Statement of Benefits was approved atter 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)end IC 8-1.1-12.1.5.3(f)). <br /> 5. The schedules established underiC 6 i.1-12.1-4(d)for rehabilitated properly apply to any economic revitalization areas d5ignated after June 30,2000, <br /> unless an alternative 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 /> • SECTION 1 ?... TA%PAYER INF.ORMATIQN.' w -... _ -, . . . <br /> Name of taxpayer <br /> The Tohar.1 Wssh:ugton Squaro I I C <br /> Address of taxpayer(nvmbw and street city state.and 2IP code) <br /> 6-44 4715 Avenue,3rd Fbcr,Long Wand Cey,KY 11101 <br /> Name of contact person Setephoio number E•mail nddroes <br /> Itbcry Anget'adm (1E 4as-5555 the!emu a lwash'ngtonapuar.i v?rnefeorn <br /> SECTION 27_ :. • - LOCATIONANDDESCRIPTION•OF..PROPOSED.PROJECTkia..r.- _• _ <br /> Name of designating body Resolution number <br /> South Bend Canon CourrCl <br /> Location or property County DLGF taxing dmslrcI number <br /> 711 W.Wastinmon Si SL Joseph <br /> Descoptbn A'raw properly Iirprevaments,redeeelopmrnt,nX tehabll'arhon(use addriorral Sheets It necessary) Estimated start dale(month.day.year) <br /> 05/79115 <br /> I no Nootog'c ago and sIgnificanl deferred maIrnenn nee Issues havo mrtn the huklmg obso'escen/n-tnan I dnmpta'e rrodamvation of batting,hdu Estmeted consplrUOn dale(rrsOnlh,dry,year) <br /> 01.'01/17 <br /> :=SECTIONk4Wg"_',W 4VESTI'MA'feirdtMPL'OYEESANDSAT ITI A Relit PaV SED�`P.ROJECT <br /> Currentnurnbcr Salaries Nrrrrberfeta:icd Salerno Nurnteradditonel Salaries <br /> 0 J t 12.00 <br /> 1 _ <br /> SECTION a• -` :'',-° c uoESTIMATED,T07A1'•COS7YANDyALUE'OF:PR pO ED.PRO-JECT • <br /> REAL ESTATE IMPROVEMENTS <br /> COST _ ASSESSED VALUE <br /> Current values -- 1 1,93 q,91'.1 <br /> Plus estimated values of proposed project 223.5037 <br /> Less values of any property being replaced <br /> Net esUrnaled values upon completion of pro ecl <br /> SECTION 5 •• • •-WASTE CONVERTEDAND OTHER'BENEFITS..PROHIISED-BY THE TAXPAYER:i`' <br /> Estimated sold waste converted(pounds) - - Estimated rlatardous waste converted(pounds) <br /> -- <br /> Other benefits <br /> • <br /> • SECTION 6 TAXPAYER CERTIFICATION. - - - <br /> I hereby certify that the representations in this statement are true. <br /> Signa.r'of autecurd repres.nta rite <br /> : — - ----- ,I <br /> Dal e signed(month,day.yea) <br /> A'ana er 9.t 6'15 <br /> ..01021111allWaIlLf I k .INI11.416,sit <br /> - <br /> -._-- - <br /> Page 1 of 2 <br />