Form Sb-1/pp - Statement Of Benefits Personal Property - 2011
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STATEMENT OF BENEFITS
FORM SB-1 / PP
PERSONAL PROPERTY
State Form 51764 (R2 / 12-11)
Prescribed by the Department of Local Government Finance
PRIVACY NOTICE
The cost and any specific individual’s
salary information is confidential; the
balance of the filing is public record
per IC 6-1.1-12.1-5.1 (c) and (d).
BEFORE
BEFORE
SECTION 1
TAXPAYER INFORMATION
Name of taxpayer
Address of taxpayer
Name of contact person
T elephone number
(
)
SECTION 2
LOCATION AND DESCRIPTION OF PROPOSED PROJECT
Name of designating body
Resolution number (s)
Location of property
County
DLGF taxing district number
Description of manufacturing equipment and/or research and development equipment
ESTIMATED
and/or logistical distribution equipment and/or information technology equipment.
START DATE
COMPLETION DATE
Manufacturing Equipment
R & D Equipment
Logist Dist Equipment
IT Equipment
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
MANUFACTURING
LOGIST DIST
R & D EQUIPMENT
IT EQUIPMENT
NOTE: Pursuant to IC 6-1.1-12.1-5.1 (d) (2) the
EQUIPMENT
EQUIPMENT
COST of the property is confidential.
ASSESSED
ASSESSED
ASSESSED
ASSESSED
COST
COST
COST
COST
VALUE
VALUE
VALUE
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 (
) ________________________
Estimated hazardous waste converted (
) ________________________
Other benefits:
SECTION 6
TAXPAYER CERTIFICATION
I hereby certify that the representations in this statement are true.
Signature of authorized representative
Title
Date signed
Page 1 of 2
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