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STATEMENT OF BENEFITS <br />a REAL ESTATE IMPROVEMENTS <br />+y State Fonn 51767 <br />/1-07) <br />,• `� Prescribed by the De partment - <br />of Local Government Finance 20 pqy 20 <br />This statement is being completed for real property that qualifies under the FORM SB- <br />❑ Redevelopment or rehabilitation of real estate improvements (IC 6- 1.1- i2.1 -4 1 !Real Property <br />� Eligible vacant building ollowing Indiana Code (check one box): <br />g (IC 6 -1.1- 12.1 -4.8) ) , <br />INSTRUCTIONS. <br />>. This statement must be submitted to the body designating the Economic Revitalization Area information from the applicant in making its decision about whether to designate an ion Ar <br />submitted to the designating body BEFORE the redeye% <br />Projects" planned or committed to after July 1; >gg7 ea prior it the public hearing if the thistae <br />pment or rehabilitation of real Property Revitalization Area. designating body requires <br />2. Approval of the designating body and areas designated after Jul p perry for which the Person wishes to clam a deduction t be <br />Y (City Council, Town Board, Coun Y 1987, require a STATEMENT OF <br />BEFORE a deduction may be a <br />3. To obtain a deduction, application PProved. tY Council, etc.) must be obtained prior to initiation of the redeye% <br />shown (1) May 10, or 2 Form 322 ERA/RE or Form 322 ER Whichever 6ENEF /TS. (IC 6- 1.1.12.1) <br />()thirty (30) days rM 3 the notice of addition 2 ERA1 VBd , new assessment ' pment or rehabilitation, <br />4, Property wne scord whose Statement township Benefits ss was 'approved is a <br />pp /icab /e, must be filed with the Count <br />show compliance with the Statement of Benefits. [IC 6-1,1-12.1-5. 1 b attach CF- is mailed to the prop <br />YAuditor by the later <br />5. The schedules established under /C 6 -1. >- 12.9.4(d) �rehabilitafrted June oe ert 1991 p perry °caner at the address <br />O and y 6-1:1-12 <br />and n 2 1 a Form 1 /Real Prop ert <br />of benefits approved on or after Jul > Y annually to the a <br />July 1, 2000. Y 2000. The schedules effective prior to Jul 1, PP11cation to <br />p p y and under lC 6-1.1-12 1-4 8(1) for vacant buildings apply to any statement <br />• Y 2000, shall continue to a <br />Name of taxpayer PPIy to a statement of benefits filed before <br />The Lebermuth •� • <br />Company Inc, <br />Address of taxpayer (number and street city, state, and Zlp code) <br />14000 Mr V4 --i__ <br />� <br />contact person — <br />L4 — <br />c713Qo,,jw <br />Of property <br />-- ..r•.� eai property improvements, -,development, or rehBabil led (use <br />Renovation of office and warehouse <br />number Salaries • <br />• <br />55 • • <br />3,000, 0 0 0 Number retained <br />• 55 <br />NOTE: Pursuant to IC 6- 1.1- 12.1 -5.1 • • • <br />is confidential. (d) (2) the COST of the property <br />Current values <br />Plus estimated values of proposed proje <br />Less values of any property being replan <br />Net estimated values <br />i, r9' upon completion of <br />- <br />Estimated solid waste converted (pounds) <br />Other benefits <br />I hereby certify that the representations in this statement are true, <br />natur on ed re re <br />/ ative <br />Page 1 of 2 <br />Telephone �number <br />,�Y Y - Z.f' - <br />County <br />sheets <br />address <br />Resolution n- ern <br />DLGF taxing .— <br />Estimated start date <br />(month, day, year) <br />9/1/2013 <br />Estimated completion date <br />(month, day, year <br />• - 11/15/2013 ) <br />Salaries <br />3,00() 1 0 0 Number additional <br />0 0 Salaries 0 <br />REAL ESTATE IMPROVEMENTS <br />COST <br />2 2!%, 0 0 0 ASSESSED VALUE <br />Estimated <br />r�r .. <br />Date signed (onth, da <br />p m Y Year) <br />D -r'G. Lori <br />