Form Sb - 1 - Statement Of Benefits - 2001

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STATEMENT OF BENEFITS
FORM
SB - 1
State Form 27167 (R7 / 12-01)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS:
1.
This statement must be submitted to the body designating the economic revitilization area prior to the public hearing if the designating body requires infor-
mation 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, or BEFORE the
redevelopment or rehabilitation of real property 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 initiation of the redevelopment or rehabilitation,
or prior to installation of the new manufacturing equipment and / or research and development equipment, BEFORE a deduction may be approved.
3.
To obtain a deduction, Form 322 ERA, Real Estate Improvements and / or Form 322 ERA / PPME and / or 322 ERA / PPR & DE, must be filed with the
county auditor. With respect to real property, Form 322 ERA must be filed by the later of: (1) May 10; or (2) thirty (30) days after a notice of increase in real
property assessment is received from the township assessor. Form 322 ERA / PPME and / or 322 ERA PPR & DE must be filed between March 1 and May
15 of the assessment year in which new manufacturing equipment and / or research and development equipment becomes assessable, 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 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(d) and IC 6-1.1-12.1-4.5 (e) effective July 1, 2000 apply to any statement of benefits filed on or after
July 1, 2000.
The schedules effective prior to July 1, 2000 shall continue to apply to those statement of benefits filed before July 1, 2000.
SECTION 1
TAXPAYER INFORMATION
Name of taxpayer
Address of taxpayer (street and number, city, state and ZIP code)
Name of contact person
Telephone number
(
)
SECTION 2
LOCATION AND DESCRIPTION OF PROPOSED PROJECT
Name of designating body
Resolution number
Location of property
County
Taxing district
Description of real property improvements and / or new manufacturing equipment and / or
ESTIMATED
research and development equipment (use additional sheets if necessary)
Start Date
Completion Date
Real Estate
New Mfg Equipment
R & DE
SECTION 3
ESTIMATE OF EMPLOYEES AND SALARIES AS RESULT OF PROPOSED PROJECT
Current number
Salaries
Number retained
Salaries
Number additional
Salaries
SECTION 4
ESTIMATED TOTAL COST AND VALUE OF PROPOSED PROJECT
Research and Development
Real Estate Improvements
Machinery
NOTE: Pursuant to IC 6-1.1-12.1-5.1 (d) (2) the
Equipment
COST of the property is confidential.
Cost
Assessed Value
Cost
Assessed Value
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) ________________________
Estimated hazardous waste converted (pounds) ________________________
Other benefits:
SECTION 6
TAXPAYER CERTIFICATION
I hereby certify that the representations in this statement are true.
Signature of authorized representative
Title
Date signed (month, day, year)

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