Statement Of Benefits Personal Property (Form SB-1-PP) {51764}

STATEMENT OF BENEFITS PERSONAL PROPERTY State Form 51764 (R4 / 11-15) FORM SB-1 / PP 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 INSTRUCTIONS : This statement must be submitted to the body designating the Economic Revitalization Area prior to the public hearing if the designating body requires 1. 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 and/or research and development equipment, and/or logistical distribution equipment and/or information technology equipment 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 installation of qualifying abatable equipment for which the person desires to claim a deduction. 3. To obtain a deduction, a person must file 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 or with the county assessor if there is no township assessor for the township. The 103-ERA must be filed between January 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 January 1 and the extended due date of that year. 4. Property owners whose Statement of Benefits was approved, must submit Form CF-1/PP annually to show compliance with the Statement of Benefits. (IC 6-1.1-12.1-5.6) 5. For a Form SB-1/PP 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/PP 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 Address of taxpayer (number and street, city, state, and ZIP code) TAXPAYER INFORMATION Name of contact person T elephone number ( SECTION 2 Name of designating body Location of property County ) LOCATION AND DESCRIPTION OF PROPOSED PROJECT Resolution number (s) DLGF taxing district number Description of manufacturing equipment and/or research and development equipment and/or logistical distribution equipment and/or information technology equipment. (Use additional sheets if necessary.) Manufacturing Equipment R & D Equipment Logist Dist Equipment IT Equipment SECTION 3 Current number Salaries ESTIMATED START DATE COMPLETION DATE ESTIMATE OF EMPLOYEES AND SALARIES AS RESULT OF PROPOSED PROJECT Number retained Salaries Number additional Salaries ESTIMATED TOTAL COST AND VALUE OF PROPOSED PROJECT MANUFACTURING LOGIST DIST R & D EQUIPMENT NOTE: Pursuant to IC 6-1.1-12.1-5.1 (d) (2) the EQUIPMENT EQUIPMENT ASSESSED ASSESSED ASSESSED COST of the property is confidential. COST COST COST VALUE VALUE VALUE SECTION 4 IT EQUIPMENT COST 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 TAXPAYER CERTIFICATION I hereby certify that the representations in this statement are true. Signature of authorized representative Printed name of authorized representative Title Date signed (month, day, year) Page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com FOR USE OF THE DESIGNATING BODY We have reviewed our prior actions relating to the designation of this economic revitalization area and find that the applicant meets the general standards adopted in the resolution previously approved by this body. Said resolution, passed under IC 6-1.1-12.1-2.5, provides for the following limitations as authorized under IC 6-1.1-12.1-2. 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 _______________________________ . NOTE: This question addresses whether the resolution contains an expiration date for the designated area. B . The type of deduction that is allowed in the designated area is limited to: 1 . Installation of new manufacturing equipment; 2 . Installation of new research and development equipment; 3 . Installation of new logistical distribution equipment. 4 . Installation of new information technology equipment; Yes Yes Yes Yes No No No No Enhanced Abatement per IC 6-1.1-12.1-18 Check box if an enhanced abatement was approved for one or more of these types. C . The amount of deduction applicable to new manufacturing equipment is limited to $ _________________ cost with an assessed value of $ ____________________. (One or both lines may be filled out to establish a limit, if desired.) D . The amount of deduction applicable to new research and development equipment is limited to $ _________________ cost with an assessed value of $ ____________________. (One or both lines may be filled out to establish a limit, if desired.) E . The amount of deduction applicable to new logistical distribution equipment is limited to $ _________________ cost with an assessed value of $ ____________________. (One or both lines may be filled out to establish a limit, if desired.) F. The amount of deduction applicable to new information technology equipment is limited to $ _________________ cost with an assessed value of $ ____________________. (One or both lines may be filled out to establish a limit, if desired.) G. Other limitations or conditions (specify)__________________________________________________________________________ H. The deduction for new manufacturing equipment and/or new research and development equipment and/or new logistical distribution equipment and/or new information technology equipment installed and f