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`"' STATEMENT OF BENEFITS
<br /> '�'''"'� 20_PAY 20_
<br /> 'Alt`l REAL ESTATE IMPROVEMENTS
<br /> ° ,.
<br /> State Form 51767(R2/1-07) _ FORM SBA I Real Property
<br /> -�'
<br /> „1e Prescribed by the Department of Local Government Finance '°
<br /> Filed In Clerk's Cffic
<br /> This statement is being completed for real property that qualifies under the following Indiana Code(check o e 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 /> INSTRUCTIONS:
<br /> 1. This statement must be submitted to the body designating the Economic Revitalization Area prior to the .ublic ,r.:" : ••.. requir s
<br /> information from the applicant in making its decision about whether to designate an Economic Revitaliz.do a 1' " f< ent must b
<br /> submitted to the designating body BEFORE the redevelopment or rehabilitation of real property for whir fl g'd I f �M
<br /> "Projects"planned or committed to after July 1, 1987,and areas designated after July 1, 1987,require a , , - - - )
<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 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 6-1.1-12.1-5.30)1
<br /> 5. The schedules established under IC 6-1.1-12.1-4(d)for rehabilitated property and under lC 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 /> Lw• /4 4 idlatr 6. M
<br /> Address f xpayer(number and street,city,state,aid ZIPode)
<br /> .___ . . 1fe '-‘44 IC4•Proilf 141.LtaiAt ' P•• - e IV, ' .2-7ti WICS-4
<br /> Name Cont. = son / Telephhoojne number E-mai address p
<br /> r/
<br /> LA/ ' V:1I... "/4"--d -". : / i„ , /+l 0 Svc€€�'C
<br /> SECTION 2 LOCATION AND DESCRIPTION OF PROPOSED PROJECT
<br /> Name of,-s•nating body . ii; -7) Resolution number
<br /> OfraittA..) .2'' otettle:7 ; (e,i LI Location of property / ,S�// _ D Coun DLGF taxing district number
<br /> /G i 4/ iii'/ .%L1 -A 7 c - / .
<br /> Description of real propRerty imnrrovernents,redevelo ment,or rehabilitation(use additional sheet if necessary) Estimated start date(month,day,year)
<br /> i-Ve, ������vvyfffrss''ss/��g-`- 4 i,g .r 3--� vc L�llatht? at' l,,$GWYAui c ,/�1o�ic A
<br /> ,4,...; �/Ctx• O�a7oO4.i � c.4...e . / ,•"?-i_ /'S Estimated completion date(month,day,year)
<br /> / 44 irct w T ���
<br /> ,�/,z �'- fit, Sc ,s dSx 64 �
<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 f EST ,9„0, D TOTAL COST AND VALUE OF PROPOSED )nJECT ,,
<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 ' _..S70 IMO €
<br /> Plus estimated values of proposed project - SO/OGO IS1,D,Ci0 r J,
<br /> Less values of any property being replaced
<br /> Net estimated values upon completion of project ' $`6O Coe - co O
<br /> SECTION 5 WASTE CONVERTED AND OTHER BENEFITS PROMISED BY THE TAXPAYER
<br /> Estimated solid waste converted(pounds) / Estimated hazardous waste converted(pounds)
<br /> Other benefits J4 !J 9,6' /0 i �/c y> � /�,dt . ��, 4 . /4
<br /> I aloc-,C- lit. cde4 -14, 4 sib ,tvr rrid 4 e ..a-s1i� /'CIO`s✓/9�oi
<br /> t y�//l1�e, n Aim-
<br /> qd r• ✓A, m. Am_mil✓ e_A„j.. ' a iQi , v, �trl�f Aci �t¢rtequi A A, ot.1;wR.,
<br /> G.2,al *..-g ;.e 4 O U.cN�er�::� , Not(t._ t�✓ 00.1e44=4,„;.i t r,.Ve', c.4 6-- -
<br /> ,.c _ Re,, -44. t 4c- a 4-C
<br /> tie. - f d...( w�e .�. v
<br /> e' 744A-e$ •
<br /> SECTION 6 TAXPAYER CERTIFICATION
<br /> I hereby certify that the representations in this st- • ent are true.
<br /> Sign: re of au orize• to'-e Title Date signe (mo th,day,year)
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