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COMPLIANCE WITH STATEMENT OF BENEFITS 20_____ PAY 20_____
REAL ESTATE IMPROVEMENTS
State Form 51766 (R6 / 4-23) FORM CF-1 / Real Property
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: PRIVACY NOTICE
1. Property owners must file this form with the county auditor and the designating body for their review regarding
the compliance of the project with the Statement of Benefits (Form SB-1/Real Property). The cost and any specific individual’s
2. This form must accompany the initial deduction application (Form 322/RE) that is filed with the county auditor. salary information is confidential; the
balance of the filing is public record per
3. This form must also be updated each year in which the deduction is applicable. It is filed with the county auditor IC 6-1.1-12.1-5.3 (k) and (l).
and the designating body before May 15 or by the due date of the real property owner’s personal property
return that is filed in the township where the property is located. (IC 6-1.1-12.1-5.3(j))
4. With the approval of the designating body, compliance information for multiple projects may be consolidated on
one (1) compliance form (Form CF-1/Real Property).
SECTION 1 TAXPAYER INFORMATION
Name of Taxpayer County
Address of Taxpayer (number and street, city, state, and ZIP code) DLGF Taxing District Number
Name of Contact Person Telephone Number Email Address
( )
SECTION 2 LOCATION AND DESCRIPTION OF PROPERTY
Name of Designating Body Resolution Number Estimated Sta rtDate (month, day, year)
Location of Property Actual Start Date (month, day, year)
Description of Real Property Improvements Estimated Completion Date (month, day, year)
Actual Completion Date (month, day, year)
SECTION 3 EMPLOYEES AND SALARIES
EMPLOYEES AND SALARIES AS ESTIMATED ON SB-1 ACTUAL
Current Number of Employees
Salaries
Number of Employees Retained
Salaries
Number of Additional Employees
Salaries
SECTION 4 COST AND VALUES
COST AND VALUES REAL ESTATE IMPROVEMENTS
AS ESTIMATED ON SB-1 COST ASSESSED VALUE
Values Before Project $ $
Plus: Values of Proposed Project $ $
Less: Values of Any Property Being Replaced $ $
Net Values Upon Completion of Project $ $
ACTUAL COST ASSESSED VALUE
Values Before Project $ $
Plus: Values of Proposed Project $ $
Less: Values of Any Property Being Replaced $ $
Net Values Upon Completion of Project $ $
SECTION 5 WASTE CONVERTED AND OTHER BENEFITS PROMISED BY THE TAXPAYER
WASTE CONVERTED AND OTHER BENEFITS AS ESTIMATED ON SB-1 ACTUAL
Amount of Solid Waste Converted
Amount of 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 (month, day, year)
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