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               STATEMENT OF BENEFITS
                                                                                                                                 FORM  SB-1 / PP
               PERSONAL PROPERTY
               State Form 51764 (R4 / 11-15)
               Prescribed by the Department of Local Government Finance                                                          PRIVACY NOTICE
                                                                                                                   Any information concerning the cost 
                                                                                                                   of the property and specific salaries paid 
                                                                                                                   to individual employees by the property 
                                                                                                                   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 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. 
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, a person must file a certified deduction schedule with the person’s personal property return on a certified deduction schedule 
   (Form 103-ERA) with the township assessor of the township where the property is situated or with the county assessor if there is no township assessor 
   for the township.  The 103-ERA must be filed between January 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 January 1 and the extended 
   due date of that year. 
4. Property owners whose Statement of Benefits was approved, must submit Form CF-1/PP annually to show compliance with the Statement of Benefits.  
   (IC 6-1.1-12.1-5.6) 
5. For a Form SB-1/PP 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/PP 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)                                                 Telephone 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
(Use additional sheets if necessary.)
                                                                                            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
NOTE: Pursuant to IC 6-1.1-12.1-5.1 (d) (2) the MANUFACTURING               R & D EQUIPMENT                LOGIST DIST             IT EQUIPMENT
                                                EQUIPMENT                                                  EQUIPMENT 
COST of the property is confidential.           COST               ASSESSED COST            ASSESSED     COST      ASSESSED        COST         ASSESSED
                                                                     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 (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                                                                            Date signed (month, day, year)

Printed name of authorized representative                                   Title

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                                                          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 _______________________________ .  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 manufacturing equipment;                                                Yes       No Enhanced Abatement per IC 6-1.1-12.1-18
   2.Installation of new research and development equipment;                                     Yes       No Check box if an enhanced abatement was 
                                                                                                              approved for one or more of these types.
   3.Installation of new logistical distribution equipment.                                      Yes       No
   4.Installation of new information technology equipment;                                       Yes       No
C.The amount of 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 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 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 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 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 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 one to twenty (1-20) years; may not 
                                                                                                           exceed twenty (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 and title of authorized member of designating body)        Telephone number                  Date signed (month, day, year)
                                                                                   (            )
Printed name of authorized member of designating body                              Name of designating body

Attested by: (signature and title of attester)                                     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.  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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