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ø....~ . ; ~ ~ . ¡¿ STATEMENT OF BENEFITS State Form 27167 (RS/11.95) .' Form 58 - t Is prescribed by the State BOIIIIrd of Tax Commiaionenr;, 1989 I FORM I 58 -, INSTRUCTIONS: 1. This statement must be submilCed to the bO!iY designating the economic reviti/izaCion area prirr to the public hearing if the designating body requires infof. mauon from the applicant in making its deciSIOn about whether to designate an Economic Reviralization Area. Olfferwise this statement must be suömitred CO the desIgnating body SEFOR.E a person installs the new manufacturing equipment. or BEFORE rtJe redevelopment or rehabilitation of real property for which the person wishes to claIm a deduction. ·Projecls~ planned or committed to after July 1. 7987 and areas designated after July 7. 1987 reqUIre a STATEMENT OF BENEFITS. (IC 6-1.1-12.1) 2. Apprf?val of the designating body (City Council. Town Board. County Council. etc.) must be obtained prior to initiaûon 01 the redevelopment or rehabilitation. or pnor to inscallacion of the new manufacturing equipment. 8EFO~E a deduction may be approved. 3. To obcain a deduction. Form 322 ERA. Real Estate Improvements and I or Form 322 ERA I PP. New Machinery. must be med with the county audtor. With respect to real properry. Form 322 ERA must be med by the later 01: (1) May 10: or (2) thirry (30) days aner a notice olincrease in real property assessment is received from the rownship assessor. Form 322 ERA I PPmusr be tiled becween March 1 and May 1S of the assessment year in which newmanufac. ruring equipment tJecomes assessable. unless a filing exrension has been obtained. A person who obtains a filing extension must (;Ie the form between March 1 and June 14 01 that year. 4. Properry owners whose Statement 01 BeneñlS was approved aner June 30. 1991 must submit Form CF _ 1 annually to show compliance with the Slatement of 8enetics. (lC 6- 7. 1-12.1·5.6) Name of taxpayer Inc. Address of taxpayer (street and number. city. staæ and ZIP code) 1250 Old State Road 67 South Name of contact person Steve Overton SECTION 2 LOCATION AND DESCRIPTION OF PROPOSEO PROJECT Name of designating body Resolution number Mooresville Town Council Location of propel'tf ¡county Taxing distnà 1250 01d State Road 67 S. Mooresvi lle Desaiption of real property improvements and I or new manufacturtng equipment ESTIMATED (use addiâonal sheecs if necessary) Start Date Completion Date See Attached Real Estate New Mfg Equipment 12/1/01 1/23/02 NOTE; Pursuant to IC 6-1.1-12.1-5.1 (d) (2) the COST olthe property is confidential. 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 CERTIFtCATION I hereb ce s~na~ærh~; / that the re resentations in this statem t are true. TItle . . /C;/' / i:; ((vU:- Dat~7 -0da~ear) . /