Free 51764.FH11 - Indiana

STATEMENT OF BENEFITS PERSONAL PROPERTY
State Form 51764 (R / 1-06)

FORM SB-1 / PP
PRIVACY NOTICE
The cost and any specific individuals salary information is confidential; the balance of the filing is public record per IC 6-1.1-12.1-5.1 (c) and (d).

Prescribed by the Department of Local Government Finance

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 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. 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 and/or information technology equipment, BEFORE a deduction may be approved 3. To obtain a deduction, a person must file a certified deduction schedule with the persons 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(f) and (g)) SECTION 1
Name of taxpayer Address of taxpayer (number and street, city, state, and ZIP code) Name of contact person T elephone number

TAXPAYER INFORMATION

( 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 COST of the property is confidential. ASSESSED ASSESSED ASSESSED 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
Signature of authorized representative

TAXPAYER CERTIFICATION I hereby certify that the representations in this statement are true.
Title Date signed (month, day, year)

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 _______________________________ . 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; Ye s Ye s Ye s Ye s No No No No

C. The amount of deduction applicable to new manufacturing equipment is limited to $ _________________ cost with an assessed value of $ ____________________. D. T h e a m o u n t o f d e d u c t i o n a p p l i c a b l e t o n e w r e s e a r c h a n d d e v e l o p m e n t e q u i p m e n t i s l i m i t e d t o $ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ c o s t w ith an asse ssed v alue of $ _________________ _ _ _ . E . The amount of deduction applicable to new logistical distribution equipment is limited to $ _________________ cost with an assessed value of $ ____________________. F. The amount of deduction applicable to new information technology equipment is limited to $ _________________ cost with an assessed value of $ ____________________. 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 first claimed eligible for deduction on or after July 1, 2000, is allowed for: 1 year 2 years 3 years 4 years 5 years ** 6 years 7 years 8 years 9 years 10 years ** ** For ERAs established prior to July 1, 2000, only a 5 or 10 year schedule may be deducted.

Also we have 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) Attested by: Telephone number Date signed (month, day, year)

(

)

Designated body

* If the designating body limits the time period during which an area is an economic revitalization area, it does not limit the length of time a taxpayer is entitled to receive a deduction to a number of years designated under IC 6-1.1-12.1-4.5