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                                                                                                         PRIVACY NOTICE 
                STATEMENT OF BENEFITS                                                           Any information concerning the cost of the            FORM 
                UTILITY DISTRIBUTABLE PROPERTY                                                  property  and  specific  salaries  paid  to  SB – 1 / UD 
                State Form 52446 (R4 / 3-23)                                                    individual  employees by the property 
                Prescribed by the Department of Local Government Finance                        owner is confidential per IC 6-1.1-12.1-5.1. 
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, research and development equipment, logistical distribution
equipment, 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, Form UD-ERA must be filed with the county assessor. Form UD-ERA must be filed between January 1 and May 15 of the
assessment year in which new manufacturing equipment, research and development equipment, logistical distribution equipment, 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/UD annually to show compliance with the Statement of Benefits.
(IC 6-1.1-12.1-5.6)
5. For a Form SB-1/UD 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/UD 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                                                             TAXPAYER INFORMATION 
Name of Taxpayer                                                                   Name of Contact Person 

Address of Taxpayer  (number and street, city, state and ZIP code)                 Title of Contact Person 

Telephone Number                          Fax Number                               Contact Telephone Number            Email Address of Contact Person 
(          )                              (          )                             (          ) 
SECTION 2                                            LOCATION AND DESCRIPTION OF PROPOSED PROJECT 
Name of Designating Body                                                                                               Resolution Number 

Location of Property                                                               County                              Taxing District 

Description of Manufacturing Equipment, Research Development Equipment, Logistical                                                           ESTIMATED 
Distribution Equipment, or Information Technology Equipment 
(Use additional sheets, if necessary)                                                                                          Sta rtDate         Completion Date 
                                                                                   Manufacturing Equipment 
                                                                                   Research & Development Equipment 
                                                                                   Logistical Distribution Equipment 
                                                                                   Information Technology Equipment 
SECTION 3                                       ESTIMATED TOTAL COST AND VALUE OF PROPOSED PROJECT 
Current Number              Salaries                     Number Retained           Salaries                  Number Additional               Salaries 

SECTION 4                                       ESTIMATED TOTAL COST AND VALUE OF PROPOSED PROJECT 
NOTE: Pursuant to IC 6-1.1-12.1-5.1(d)(2) the        Manufacturing Equipment      Research & Development     Logistical Distribution         Information Technology 
                                                                                   Equipment                         Equipment               Equipment 
COST of the property is confidential.                  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) __________________________________        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) 

Printed Name of Authorized Representative                                          Email Address                       Telephone Number 
                                                                                                                       (          ) 

                                                                                  Page 1 of 2 

                                                               FOR USE BY 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  anufacturing M quipmentE                                ☐ Yes ☐ No               ☐ Enhanced Abatement per IC 6-1.1-12.1-18
   2. Installation of New  esearchR and  evelopment D  quipmentE                   ☐ Yes ☐ No                 (Check box if an enhanced abatement was
   3. Installation of New  ogistical L istribution D quipmentE                     ☐ Yes ☐ No                 approved for one or more of these types.)
   4. Installation of New  nformation I echnology T  quipmentE                     ☐ Yes ☐ No

C. The amount of the 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 the 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 the 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 the 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 new,          research and development equipment new,      logistical distribution equipment or, new information
   technology equipment installed and first claimed    as eligible for the deduction is allowed for:
      ☐ Year 1               ☐ Year 2                ☐ Year 3           ☐ Year 4         ☐ Year 5           ☐ Enhanced Abatement per IC 6-1.1-12.1-18
                                                                                                                       Number of Years Approved: ___________
      ☐ Year 6               ☐ Year 7                ☐ Year 8           ☐ Year 9         ☐ Year 10                     (Enter 1-20 years; may not exceed 20 years)
I. For a Statement of Benefits approved after June 30, 2013, did this designating body adopt an abatement schedule per IC 6-1.1-12.1-17?
      ☐ Yes                    ☐ No
   If yes, attach a copy of the abatement schedule to this form. 
   If no, the designating body is required to establish an abatement schedule before the deduction can be determined. 
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 By: (signature)                                                           Title of Authorized Member of Designating Body 

Email Address                                          Telephone Number                                     Date Signed (month, day, year) 
                                                       (         )
Printed Name of Authorized Member of Designating Body                              Name of Designating Body 

Attested By: (signature)                                                           Printed Name of Attester 

* If the designating body limits the time period during which an area is an economic revitalization area, that limitation does not limit the length of time a
taxpayer is entitled to receive a deduction to a number of years that is less than the number of years designated under IC 6-1.1-12.1-17.

IC 6-1.1-12.1-17 
Abatement Schedules 
Sec. 17. (a) A designating body may provide to a business that is established in or relocated to a revitalization area and that receives a deduction under section 4 or 4.5 of 
this chapter an abatement schedule based on the following factors: 
   (1) The total amount of the taxpayer’s investment in real and personal property.
   (2) The number of new full-time equivalent jobs created.
   (3) The average wage of the new employees compared to the state minimum wage.
   (4) The infrastructure requirements for the taxpayer’s investment.
(b) This subsection applies to a statement of benefits approved after June 30, 2013. A designating body shall establish an abatement schedule for each deduction allowed
under this chapter. An abatement schedule must specify the percentage amount of the deduction for each year of the deduction. Except as provided in IC 6-1.1-12.1-18(d),
an abatement schedule may not exceed ten (10) years.
(c) An abatement schedule approved for a particular taxpayer before July 1, 2013, remains in effect until the abatement schedule expires under the terms of the resolution
approving the taxpayer’s statement of benefits.
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