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STATEMENT OF BENEFITS <br />REAL ESTATE IMPROVEMENTS <br />State Form 51767 (R2 / 1 -07) <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 />❑ 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 I 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 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 maybe 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 - 5.36)1 <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 />TAXPAYER INFORMATION of taxpayer <br />A�reess f taxpayer (number and city, <br />street, state, end Z/PCOde) <br />i. N GQq _� SN C165-30 <br />Name of contact person Tele hone number <br />EP <br />E- <br />mail address <br />SECTION • • AND DESCRIPTION OF -••• r PROJECT <br />Name of designating body <br />Resolution number <br />rI <br />L <br />Loca ion of property ^ y'� �� County ^ <br />DLGF taxing district number <br />Description of real property improvements, redevelopment, or rehabilitation (use additional sheets if necessary) <br />A,VGw R&w6'AA #vRDX 2,00 ,%le FTW1A 2 �K <br />stimatteed`start date , day, year) <br />Estimated completion date (month, day, year) <br />M/'F AAV AR QVA A r.� <br />