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,... i <br />In <br />20 PAY PAY 20_ <br />STATEMENT OF BENEFITS <br />P REAL ESTATE IMPROVEMENTS State Form 51767 (R211 -07) FORM S13-1 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 followi g Indi a odej Qh 10. 114 <br />❑ Redevelopment or rehabilitation of real estate improvements (IC 6 -1.1- 12.1 -4) CfiY CLERK+ <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 CountyAuditor 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)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 />taxpayer <br />Address df taxpayer (number and st eet, city, st9te, and ZIP code) <br />;2 00/ , W • G>r� - Jr S o v 7f� _Z;V 6 d <br />Name of con tart person Telephone number E -mail address ,,// � <br />., . -. <br />Name of designating body Resolution number <br />C4000AW d C/L 2 / cJOV% •D END <br />Location of property Coun DLGF taxing district number <br />SEg 1" AESZ R I �EGrio� ,l ,q& ✓E S s EPs� <br />Description of real property improvements, redevelopment, or rehabilitation (use additional sheets if necessary) Estimated start date (month, day, year) <br />Scw- 45(111a17 `C ' AL77Ac&6Z • 3 — / <br />T> - // Estimated completion date (month, da , year), <br />N �ieO T�GT c[i�'Sci2 �i° TivitJ SEG % �oA -7 —9/ _ 0!1 <br />Current number Sal ri e s Number retained <br />116 , /3 7 ,6141 <br />Salaries <br />6, 137 lvi5� <br />Number additional Salaries <br />aP I /, 39d <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. OR16yN/9L COST ASSESSED VALUE <br />Current values 0 <br />Plus estimated values of proposed project <br />Less values of any property being replaced <br />Net estimated values upon completion of project 7. 7 ✓�S Z ° <br />Estimated solid waste converted (pounds) } Estimated hazardous waste converted (pounds) <br />Other benefits <br />I hereby certify that the representations in this statement are true. <br />Signature of a d representative Title Date signed (m n, da ,year) <br />, d th <br />-- C. - _ F o. , 7; <br />Page 1 of 2 <br />