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~~` °"•4 STATEMENT OF BENEFITS <br />REAL ESTATE IMPROVEMENTS <br />0~` tea. ~ ~ State Form 51767 (R2 ! i-07) <br />•~~~ ~ Prescribed by the Department of Local Government Finance <br />,.,. <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 (IC 6-1.1-12.1-4.8) <br />20_ PAY 20_ <br />FORM SB-1 /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 ifs decision about whether to designate an Economic Revitatization Area. Otherwise this statement musf 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 ERA/VBD, Whichever is applicable, must be fried with the CountyAuditor by the later <br />of.• (i) 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 afrer June 30, 1991, musf attach a Form CF-1/Real Property annually to the application to <br />show compliance with the Statement ofBenefits. (IC 6-1.1-12.1-5.1(b) and /C 6-1.1-12.1-5.3~)j <br />5. The schedules established under IC 6-1.1-12.1-4(d) for rehabilitated property and under 1C 6-1.1-12.1-4.8(1) for vacant buildings apply to any statement <br />of benefits approved on or aRer July 1, 2DD0. The schedules effective prior to July 1, 2000, shall continue to apply fo a statement of benefits fried before <br />Jury ,, cvvv. <br />• •" ~ <br />Name of taxpayer <br />~,. .~ <br />Address of taxpayer (n tuber and street, city, state, and ZIP c eJ' ' <br /> <br />Name of contact person ~ /`/ /~ Telephone num~be~rJ ~ E-malil~a~dd`ress / <br /> <br />Name of designating body Resolution number <br />Location of property <br />'f Count~~~ ' ~ DLGF taxin istrict number ~ <br />- <br />U~¢ 2~1d i~ <br />Description of real property improvements, redevelopm nt, or rehabilitation (use additional sheets if ne ssa Estimate start 'te (month, day, year} <br /> <br /> Estimat rGon d month, day, yeah <br /> /`/ Q,(/r <br /> -.•. -. <br />Current number Salaries Number retained Salaries Number additional Salaries <br /> <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 ~ ~ ~O0 <br /> <br />Plus estimated values of proposed project <br />Less values of any property being replaced <br />~'G <br />Net estimated values upon completion of project <br />~ • . . ~ -• <br />Estimated solid waste converted (pounds) Estimated hazardous waste converted (pounds) <br /> <br />Other benefits m~gg,t <br />~~~~+,~ +~ ~~+~~ ~~~'+ V t~l~+~ <br />- ~Y,AR - 5 2008 <br /> JGi;Pt VJGADE <br /> CITY CLERK, cG. Bc!tD,1N. <br />• <br />I hereby certify that the representations in this statement are true. <br />Signature of aut nze re e e Title Date sign (mont ,year) <br /> <br />Nage 't of z <br />