Free 52446.FH11 - Indiana

STATEMENT OF BENEFITS UTILITY DISTRIBUTABLE PROPERTY
State Form 52446 (12-05) Prescribed by the Department of Local Government Finance

FORM SB - 1 / UD

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, Form UD-ERA must be filed with the county auditor. Form UD-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 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 / UD 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. 6. This form is for use 2006 pay 2007 and after. SECTION 1 Name of taxpayer Address of taxpayer (number and street, city, state and ZIP code) T elephone number ( ) SECTION 2 Name of designating body Location of property Fax number ( TAXPAYER INFORMATION Name of contact person Title of contact person Telephone number E-mail address of contact person

( ) ) LOCATION AND DESCRIPTION OF PROPOSED PROJECT Resolution number County Taxing district ESTIMATED Start Date Completion Date
Manufacturing Equipment Research & Development Equipment Logistical Distribution Equipment * Information Technology Equipment *

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)

SECTION 3 Current number SECTION 4

ESTIMATE OF EMPLOYEES AND SALARIES AS RESULT OF PROPOSED PROJECT Salaries Number retained Salaries Number additional ESTIMATED TOTAL COST AND VALUE OF PROPOSED PROJECT
Manufacturing Equipment Research & Development Equipment Logistical Distribution Equipment *

Salaries

NOTE: Pursuant to IC 6-1.1-12.1-5.1 (d) (2) the COST of the property is confidential.

Information Technology Equipment *

Cost

Assessed Value

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) ________________________ Other benefits: Estimated hazardous waste converted (pounds) ________________________

SECTION 6 Signature of authorized representative E-mail address * See IC 6-1.1-12.1-2.3.

TAXPAYER CERTIFICATION

I hereby certify that the representations in this statement are true.
Title T elephone number ( ) Date signed (month, day, year) Fax number ( )

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; Yes Yes Yes Yes No No No No

C . The amount of deduction applicable to new manufacturing equipment is limited to $ _________________ cost with an assessed value of $ ____________________. D . The amount of deduction applicable to new research and development equipment is limited to $ _________________ cost with an assessed value 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 after July 1, 2000 is allowed for: ** For ERAs established prior to July 1, 2000 only a 1 year 6 years 2 years 7 years 5 or 10 year schedule may be deducted. 3 years 8 years 4 years 9 years 5 years ** 10 years ** 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) Telephone number ( Attested by: ) 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