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STATEMENT OF BENEFITS
<br /> d��• `� 20 PAY 20
<br /> REAL ESTATE IMPROVEMENTS
<br /> '.i ` l'/ State Form 51767(R2/1-07) FORM SB-1 I Real Property
<br /> ,;,; Prescribed by the Department of Local Government Finance
<br /> .This statement is being completed for real property that qualifies under the following Indiana Code(check one box): .
<br /> 16 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 /> 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 may be approved.
<br /> 3. To obtain a deduction,application Form 322 ERA/RE or Form 322 ERA/VBD, 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/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 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 /> SECTION 1 TAXPAYER INFORMATION
<br /> Name of taxpayer
<br /> 6, �
<br /> r n-PA
<br /> Addre s of tax ayer(number and street,city,state,and ZIP code)
<br /> 4 o i4y:04 MefboW cr., E b wi9.4 04)0, rkNL FtitL
<br /> Name of contact person Telephone number
<br /> p E-mail address
<br /> 1fJELtt�2 -9-232-'3v(otp IoL� jucK.ws.t -&�fI-rtio..-Q
<br /> SECTION 2 LOCATION AND DESCRIPTION OF PROPOSED PROJECT
<br /> Name of designating body Resolution number
<br /> 2J '1 Pt D rot aT J t '4.4-
<br /> Location of property County DLGF taxing district number
<br /> 330o pot,'1-k r--e-PnAo , 5;vrtAk C ib: f' 4,(:,28 s+. Spsol-t Geani. ot8
<br /> Description of real property improvements,redevelopment,or rehabilitation(use additional sheets if necessary) Estimated start date(month,day,year)
<br /> 5000 sca-Fr. rY 3J('FPKnt(ti(,, A-o04-31-tai-) fvt- !}00��r'i-t rfv7-0k* cti 10- l-201 t
<br /> ID YtiAi L N C w 1 M1-(of CU,--1-01/hU, Estimated completion date(month,day,year)
<br /> 3-1- zo V3
<br /> SECTION 3 ESTIMATE OF EMPLOYEES AND SALARIES AS RESULT OF PROPOSED PROJECT
<br /> Current number Salaries Number retained Salaries Number additional Salaries
<br /> 10 a,5 O0,000 10 2,500l00 0 20 900000
<br /> S •N4 S IT •TOTAL • _ • _ • •ze•• • •r a
<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 1 LIS4r©00 f't3R.000
<br /> Plus estimated values of proposed project 0 000
<br /> Less values of any property being replaced . t_ .
<br /> Net estimated values upon completion of project .at i e`j ODU
<br /> SECTION 5 WASTE CONVERTED AND OTHER is ENEFITS PROMISED BY THE TAXPAYER
<br /> Estimated solid waste converted(pounds) Estimated hazardous waste converted(pounds) '49.
<br /> Other benefits r --
<br /> ' .QA • yk R-ovr-a.vNL 0 D ( wo � Tit) ST- To c 44c:11 ;y,. -
<br /> k
<br /> L '?r It.', !;, t i
<br /> I r'U ; cLEL i,, ; ., '
<br /> SECTION 8 • TAXPAYER CERTIFICATION •
<br /> I he eby certify that the representations in this statement are true.
<br /> Signatut:�']tho iz d r't• entative Title
<br /> ��ff �, ��� (' Date sign d(month,day,year)
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