02-23-09 Common Council Meeting Agenda & Packet

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STATEMENT OF BENEFITS a PERSONAL PROPERTY . „a State Form 51764 (R 11-06) Prescribed by the Department of Local Government Finance INSTRUCTIONS: fElE CWTI'''s Olilce :V0Qr,0E,, 2009 JOH CRY Ct6HK� S0. , IN. FORM SBA / PP PRIVACY NOTICE The cost and any specific individual's salary information is confidential; the balance of the filing is public record p er IC 6 -1.1- 12.1 -5.1 (c and d). 1. This statement must be submitted to the body designating the Ecohomi a cation Area prior to the public hearing if the designating body requires information from the applicant in making its decision about whether to designate an Economic Revitalization Area. Otherwise this statement must be submitted to the designating body BEFORE a person installs the new manufacturing equipment andlor research and development equipment, and/or logistical distribution equipment and /or information technology equipment for which the person wishes to claim a deduction. "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) 2. Approval of the designating body (City Council, Town Board, County Council, etc.) must be obtained prior to installation of the new manufacturing equipment and/or research and development equipment and/or logistical distribution equipment andlor information technology equipment, BEFORE a deduction may be approved 3. To obtain a deduction, a person must rile a certified deduction schedule with the person's personal property return on a certified deduction schedule (Form 103 -ERA) with the township assessor of the township where the property is situated. The 103 -ERA must be filed between March 1 and May 15 of the assessment year in which new manufacturing equipment and/or research and development equipment and/or logistical distribution equipment and/or information technology equipment is installed and fully functional, unless a filing extension has been obtained. A person who obtains a filing extension must file the form between March 1 and the extended due date of that year. 4. Property owners whose Statement of Benefits was approved after June 30, 1991, must submit Form CF -1 / PP annually to show compliance with the Statement of Benefits. (IC 6 -1.1- 12.1 -5.6) 5. The schedules established under IC 6 -1.1- 12.1- 4.5(d) and (e) apply to equipment installed after March 1, 2001. For equipment installed prior to March 2, 2001, the schedules and statutes in effect at the time shall continue to apply. (IC 6- 1.1- 12.1- 4.5(t) and (g)) 9" Name of taxpayer RV ,4 L HOLJINI/(S —L�G . Address of taxpayer (number and treet, city - state, and ZIP code) Z/✓ 19/ W. S /iV T/I 7 Name of contact person y 5 717A/ke Telephone number - 2 F PROPOSED PRO Cf�` Name of de body G L' st7vTl/ Resolution number (s) [- MNON /� of /? OF .�EN,rj Location of property p Cou DLGF taxing district number a?801 A4 Wr#iA/ Tit/ I tJOVT ✓D -TAI JT �TOSEPN Description of manufacturing equipment and /or research and developmenf equipment ESTIMATED and /or logistical distribution equipment and /or information technology equipment. START DATE COMPLETION DATE (use additional sheets if necessary) Manufacturing Equipment 7,/ 0 9 2'/2-r / O ,S,'W Li1CH //9 /T t ' �'l7/�Gff� R & D Equipment tt ,C'SC� /PTid/V Of �l�(/ /PiKl Logist Dist Equipment SL�GTion/ IT Equipment Current number Salar es Number retained Salaries Number additional Salaries aF �3yo, �aG S ECt 4 ESTIMATED TOTAL COST AN b VAL6 E OF PROP OSED PROJ ECT NOTE: Pursuant to IC 6 1.1 12.1 - 5.1 (d) (2) the M E U U P MENTNG R & D EQUIPMENT EQU P MENT IT EQUIPMENT COST of the property is confidential. ASSESSED COST ASSESSED COST ASSESSED COST ASSESSED VALUE VALUE VALUE VALUE Current values 7S3oio oS Plus estimated values of proposed project Less values of any property being replaced — ' Net estimated values upon completion of project 3 3i0 /L Estimated solid waste converted (pounds) Estimated hazardous waste converted (pounds) A1114 Other benefits: • d, 0113 • I hereby certify that the representations in this statement are true. Signature of a d representative Title Date signed (m nth, da year) 9"