Statement Of Benefits Real Estate Improvements {51767}

STATEMENT OF BENEFITS REAL ESTATE IMPROVEMENTS State Form 51767 (R6 / 10-14) 20____ PAY 20____ FORM SB-1 / Real Property PRIVACY NOTICE Any information concerning the cost of the property and specific salaries paid to individual employees by the property owner is confidential per IC 6-1.1-12.1-5.1. Prescribed by the Department of Local Government Finance This statement is being completed for real property that qualifies under the following Indiana Code (check one box): Redevelopment or rehabilitation of real estate improvements (IC 6-1.1-12.1-4) Residentially distressed area (IC 6-1.1-12.1-4.1) INSTRUCTIONS: 1. This statement must be submitted to the body designating the Economic Revitalization 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 the redevelopment or rehabilitation of real property for which the person wishes to claim a deduction. 2. The statement of benefits form must be submitted to the designating body and the area designated an economic revitalization area before the initiation of the redevelopment or rehabilitation for which the person desires to claim a deduction. 3. To obtain a deduction, a Form 322/RE must be filed with the County Auditor before May 10 in the year in which the addition to assessed valuation is made or not later than thirty (30) days after the assessment notice is mailed to the property owner if it was mailed after April 10. A property owner who failed to file a deduction application within the prescribed deadline may file an application between March 1 and May 10 of a subsequent year. 4. A property owner who files for the deduction must provide the County Auditor and designating body with a Form CF-1/Real Property. The Form CF-1/Real Property should be attached to the Form 322/RE when the deduction is first claimed and then updated annually for each year the deduction is applicable. IC 6-1.1-12.1-5.1(b) 5. For a Form SB-1/Real Property that is approved after June 30, 2013, the designating body is required to establish an abatement schedule for each deduction allowed. For a Form SB-1/Real Property that is approved prior to July 1, 2013, the abatement schedule approved by the designating body remains in effect. IC 6-1.1-12.1-17 SECTION 1 Name of taxpayer TAXPAYER INFORMATION Address of taxpayer (number and street, city, state, and ZIP code) Name of contact person T elephone number E-mail address ( SECTION 2 Name of designating body ) Resolution number LOCATION AND DESCRIPTION OF PROPOSED PROJECT Location of property County DLGF taxing district number Description of real property improvements, redevelopment, or rehabilitation (use additional sheets if necessary) Estimated start date (month, day, year) Estimated completion date (month, day, year) SECTION 3 Current number Salaries ESTIMATE OF EMPLOYEES AND SALARIES AS RESULT OF PROPOSED PROJECT Number retained Salaries Number additional Salaries SECTION 4 ESTIMATED TOTAL COST AND VALUE OF PROPOSED PROJECT COST REAL ESTATE IMPROVEMENTS ASSESSED VALUE Current values Plus estimated values of proposed project Less values of any property being replaced Net estimated values upon completion of project SECTION 5 WASTE CONVERTED AND OTHER BENEFITS PROMISED BY THE TAXPAYER Estimated solid waste converted (pounds) ________________________ Other benefits Estimated hazardous waste converted (pounds) ___________________ SECTION 6 Signature of authorized representative TAXPAYER CERTIFICATION Date signed (month, day, year) I hereby certify that the representations in this statement are true. Printed name of authorized representative Title Page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com FOR USE OF THE DESIGNATING BODY We find that the applicant meets the general standards in the resolution adopted or to be adopted by this body. Said resolution, passed or to be passed under IC 6-1.1-12.1, provides for the following limitations: A. The designated area has been limited to a period of time not to exceed ____________ calendar years* (see below). The date this designation expires is _______________________________. B. The type of deduction that is allowed in the designated area is limited to: 1. Redevelopment or rehabilitation of real estate improvements 2. Residentially distressed areas Yes Yes No No C. The amount of the deduction applicable is limited to $ __________________. D. Other limitations or conditions (specify)__________________________________________________________________________ E. Number of years allowed: Year 1 Year 6 Year 2 Year 7 Year 3 Year 8 Year 4 Year 9 Year 5 (* see below) Year 10 F. For a statement of benefits approved after June 30, 2013, did this designating body adopt an abatement schedule per IC 6-1.1-12.1-17? Yes No If yes, attach a copy of the abatement schedule to this form. If no, the designating body is required to establish an abatement schedule before the deduction can be determined. We have also reviewed the information contained in the statement of benefits and find that the estimates and expectations are reasonable and have determined that the totality of benefits is sufficient to justify the deduction described above. Approved (signature and title of authorized member of designating body) Telephone number Date signed (month, day, year) ( Printed name of authorized member of designating body ) Name of designating body Attested by (signature and title of attester) Printed name of attester * If the designating body limits the time period during which an area is an economic revitalization area, that limitation does not limit the length of time a taxpayer is entitled to receive a deduction to a number of years that is less than the number of years designated under IC 6-1.1-12.1-17. A. For residentially distressed areas where the Form SB-1/Real Property was approved prior to July 1, 2013, the deductions established in IC 6-1.1-12.1-4.1 remain in effect. The deduction period may not exceed five (5) years. For a Form SB-1/Real Property that is approved after June 30, 2013, the designating body is required to establish an abatement schedule for each deduction allowed. The deduction period may not exceed ten (10) years. (See IC 6-1.1-12.1-17 below.) B. For the redevelopment or rehabilitation of real property where the Form SB-1/Real Property was approved prior to July 1, 201