HomeMy Public PortalAbout10 - 2022-10 - HEARTLAND AUTOMOTIVE COMPLIANCE WITH STATEMENT OF BENEFITS RESOLUTION NO. 2022 - 10
COMMON COUNCIL OF THE CITY OF GREENCASTLE, INDIANA
A RESOLUTION AFFIRMING
HEARTLAND AUTOMOTIVE, LLC,
OF COMPLIANCE WITH STATEMENTS OF BENEFITS
WHEREAS, Heartland Automotive, LLC, has heretofore been granted certain tax
abatements in consideration of certain benefits for the City of Greencastle; and,
WHEREAS, said company has submitted the following forms as of May 16, 2022:
CF-1/PP for tax abatement on equipment granted in 2013,
CF-1/PP for tax abatement on equipment granted in 2016,
CF-1/PP for tax abatement on equipment granted in 2017, and
CF-1/PP for tax abatement on equipment granted in 2018.
WHEREAS, the Common Council has reviewed the CF-1 forms, copies of which are
attached hereto, and has found compliance with the previously approved Statements of Benefits.
NOW THEREFORE BE IT RESOLVED that the Common Council of the City of
Greencastle, Putnam County, Indiana, approves the CF-1 forms as submitted as being in
compliance with the Statements of Benefits previously filed by Heartland Automotive LLC.
BE IT FURTHER RESOLVED that this Resolution be made a record and filed along with
the CF-1 forms with the Putnam County Auditor.
PASSED by the Common Council of the City of Greencastle at its regular meeting this 7th
day of July 2022.
COMMON COUNCIL OF THE CITY OF REENCASTLE, INDIANA
Adam Cohe Co ert
Art ►_.haAda ..
ammer facie gdo
' '
Pqr Murra / I Veronica ejril
Darrel Thomas
Approved and signed by me this 7th day of July 2022 at `f: 3\ p.m. o'clock.
it iam A. Dory, Jr., May
ATTES
,17
yz da R. Dunbar, Clerk-Treasurer
. COMPLIANCE WITH STATEMENT OF BENEFITS PERSONAL PROPERTY
PRIVACY NOTICE FORM CF-1 /PP
This form contains confidential
information pursuant to
State Form 51765(R6/12-21) IC 6-1.1-35-9 and IC 6-1.1-12.1-5.6. January 1,2022
F Prescribed by the Department of Local Government Finance
INSTRUCTIONS: 1. Property owners whose Statement of Benefits was approved must file this form with the local Designating Body to show the extent
to which there has been compliance with the Statement of Benefits. (IC 6-1.1-12.1-5.6)
2. This form must be filed with the Form 103-ERA Schedule of Deduction from Assessed Value between January 1 and May 16,2022,
unless a filing extension under IC 6-1.1-3.7 has been granted. A person who obtains a filing extension must file between
January 1 and the extended due date of each year.
3. With the approval of the designating body, compliance information for multiple projects may be consolidated on one(1)compliance(CF-1).
•ECTION 1 TAXPAYER INFORMATION
Name of taxpayer County
Heartland Automotive, LLC Tippecanoe
Address of taxpayer(number and street,city,state,and ZIP code) DLGF taxing district number
300 S. Warren Drive, Greencastle, IN 46135 67-008
Name of contact person Telephone number
Ritsuko Murakami Abrams (765 ) 653-4263
•ECTION 2 LOCATION AND DESCRIPTION OF PROPERTY
Name of designating body Resolution number Estimated start date(month,day,year)
Greencastle City Council 2013-1 &3
Location of property Actual start date(month,day,year)
300 S.Warren Drive, Greencastle, IN 46135
Description of new manufacturing equipment,or new research and development equipment,or new information technology Estimated completion date(month,day,year)
equipment,or new logistical distribution equipment to be acquired.
2 Injection Molding machines, 1 slush Molding Machine, 2 Interior Paint Booths, 1 Headliner Actual completion date(month,day year)
Stamping Machine and Ancilliary Equipment
.ECTION 3 EMPLOYEES AND SALARIES
EMPLOYEES AND SALARIES AS ESTIMATED ON SB-1 ACTUAL
Current number of employees 405 428
Salaries 14,313,725 18,269,903
Number of employees retained 405 405
Salaries 14,313,725 14,313,725
Number of additional employees 23
Salaries
3,956,178
•ECTION 4 COST AND VALUES
MANUFACTURING R&D EQUIPMENT LOGIST DIST IT EQUIPMENT
EQUIPMENT EQUIPMENT
COST ASSESSED ASSESSED ASSESSED ASSESSED
AS ESTIMATED ON SB-1 VALUE COST VALUE COST VALUE COST VALUE
Values before project
Plus: Values of proposed project 4,000,000
Less: Values of any property being replaced
Net values upon completion of project 4,000,000
ACTUAL ASSESSED ASSESSED ASSESSED ASSESSED
COST VALUE COST VALUE COST VALUE COST VALUE
Values before project
Plus: Values of proposed project 5,255,015 980,004
Less: Values of any property being replaced
Net values upon completion of project 5,255,015 980,004
NOTE:The COST of the property is confidential pursuant to IC 6-1 1-12.1-5.6(c).
•ECTION 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:
ECTION 6 TAXPAYER CERTIFICATION
I hereby certify that the represent tions in this statement are true.
Signature of authorized representative I Titie w Date sign j(rppry,O,day,year)
i/ Page 1 of 2
OPTIONAL: FOR USE BY A DESIGNATING BODY WHO ELECTS TO REVIEW THE COMPLIANCE WITH STATEMENT OF BENEFITS(FORM CF-1)
INSTRUCTIONS: (iC 6-1.1-12.1-5.9)
1. Within forty-five(45)days after receipt of this form,the designating body may determine whether or not the property owner has substantially complied with
the Statement of Benefits.
2. If the property owner is found NOT to be in substantial compliance, the designating body shall send the property owner written notice. The notice must
include the reasons for the determination,including the date;time and place of a hearing to be conducted by the designating body.if a notice is mailed to
a property owner,a copy of the written notice will be sent to the county assessor and the county auditor.
3. Based on the information presented at the hearing,the designating body shall determine whether or not the property owner has made reasonable effort to
substantially comply with the Statement of Benefits and whether any failure to substantially comply was caused by factors beyond the control of the
property owner.
4. If the designating body determines that the property owner has NOT made reasonable effort to comply,the designating body shall adopt a resolution
terminating the deduction. The designating body shall immediately mail a certified copy of the resolution to:(1)the property owner;(2)the county auditor'
and(3)the county assessor.
We have reviewed the CF-1 and find that:
Lig the property owner IS in substantial compliance
❑ the property owner IS NOT in substantial compliance
❑ other(specify)
Reasons for the determination(attach additional sheets if necessary)
Signature of auth ' e me ber _ , —Date signed(month,day,year)
1.6 ile604.44444/ :r0t-4
Attested by . Designating body
G2��cstsfl� Co.YciV/Or✓ �,ovik)CrL
If he property owner is found not to be in substantial compliance,the property owner shall receive the opportunity for a hearing.The following date and
time has been set aside for the purpose of considering compliance.
Time of hearing ❑AM Date of hearing(monrJt.day,year) Location of hearing
-__—_-❑PM I _._
HEARING RESULTS(to be completed after the hearing)
❑ Approved ❑ Denied(see instruction 5 above)
Reasons for the determination(attach additional sheets if necessary)
t i
1 I
Signature of authorized member 1 Date signed(month,day,year)
Attested by: — Designating body
APPEAL RIGHTS[iC 6-1.1-12.1-5.9(e)]
A property owner whose deduction is denied by the designating body may appeal the designating body's decision by filing a complaint in the office of the
clerk of Circuit or Superior Court together with a bond conditioned to pay the costs of the appeal if the appeal is determined against the property owner.
Page 2 of 2
• COMPLIANCE WITH STATEMENT OF BENEFITS PRIVACY NOTICE 1
t?1: a FORM CF-1 /PP
.- . PERSONAL PROPERTY This form contains confidential
information1- 5-9a ICpu 6 1.1-10 January1, 2022
• State Form 51765(R6/12-21) IC 6-1.1-35-9 and IC 6-1.1-12.1-5.6.
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: 1. Property owners whose Statement of Benefits was approved must file this form with the local Designating Body to show the extent
to which there has been compliance with the Statement of Benefits. (IC 6-1.1-12.1-5.6)
2. This form must be filed with the Form 103-ERA Schedule of Deduction from Assessed Value between January 1 and May 16,2022,
unless a filing extension under IC 6-1.1-3.7 has been granted. A person who obtains a filing extension must file between
January 1 and the extended due date of each year.
3. With the approval of the designating body,compliance information for multiple projects maybe consolidated on one(1)compliance(CF-1).
•ECTION 1 TAXPAYER INFORMATION
Name of taxpayer County
Heartland Automotive, LLC Tippecanoe
Address of taxpayer(number and street,city,state,and ZIP code) DLGF taxing district number
300 S. Warren Drive, Greencastle, IN 46135 67-008
Name of contact person Telephone number
Ritsuko Murakami Abrams (765 ) 653-4263
.ECTION 2 LOCATION AND DESCRIPTION OF PROPERTY
Name of designating body Resolution number Estimated start date(month,day,year)
Greencastle City Council 2016-1 06/01/2016
Location of property Actual start date(month,day,year)
300 S. Warren Drive, Greencastle, IN 46135
Description of new manufacturing equipment,or new research and development equipment,or new information technology Estimated completion date(month,day,year)
equipment,or new logistical distribution equipment to be acquired. 12/01/2016
Headliner Stamping, Headliner Assembly, Tier Cut, Powder Slush, Apron Press, Weather Actual completion date(month,day,year)
Strip Rivet, Door Upper Trim
.ECTION 3 EMPLOYEES AND SALARIES
EMPLOYEES AND SALARIES AS ESTIMATED ON SBA ACTUAL
Current number of employees 389 428
Salaries 15,760,060 18,269,903
Number of employees retained 405 405
Salaries 15,760,060 15,760,060
Number of additional employees 43 23
Salaries 1,148,160 2,509,843
.ECTION 4 COST AND VALUES
MANUFACTURING R&D EQUIPMENT LOGIST DIST IT EQUIPMENT
EQUIPMENT EQUIPMENT
AS ESTIMATED ON SBACOST ASSESSED ASSESSED ASSESSED ASSESSED
VALUE COST VALUE COST VALUE COST VALUE
Values before project
Plus: Values of proposed project 8,286,727
Less: Values of any property being replaced
Net values upon completion of project 8,286,727
ACTUAL ASSESSED ASSESSED ASSESSED ASSESSED
COST VALUE COST VALUE COST VALUE COST VALUE
Values before project
Plus: Values of proposed project 9,000,000 3,780,000
Less: Values of any property being replaced
Net values upon completion of project 9,000,000 3,780,000
NOTE:The COST of the property is confidential pursuant to IC 6-1.1-12.1-5.6(c).
.ECTION 5 WASTE CONVERTED AND OTHER BENEFITS PROMISED BY THE TAXPAYER
WASTE CONVERTED AND OTHER BENEFITS AS ESTIMATED ON SBA ACTUAL
Amount of solid waste converted
Amount of hazardous waste converted
Other benefits:
.ECTION 6 TAXPAYER CERTIFICATION
I hereby certify that the representations i//P this statement are true.
Signature of authorized representative . t l`. Title Date signed(month,day,year)
v' Page 1 of 2
OPTIONAL: FOR USE BY A DESIGNATING BODY WHO ELECTS TO REVIEW THE COMPLIANCE WITH STATEMENT OF BENEFITS(FORM CF-I)
INSTRUCTIONS: (IC 6-1.1-12.1-5.9)
1. Within forty-five(45)days after receipt of this form,the designating body may determine whether or not the property owner has substantially complied with
the Statement of Benefits.
2. If the property owner is found NOT to be in substantial compliance, the designating body shall send the property owner written notice. The notice must
include the reasons for the determination,including the date,time and place of a hearing to be conducted by the designating body. If a notice is mailed to
a property owner,a copy of the written notice will be sent to the county assessor and the county auditor.
3. Based on the information presented at the hearing,the designating body shall determine whether or not the property owner has made reasonable effort to
substantially comply with the Statement of Benefits and whether any failure to substantially comply was caused by factors beyond the control of the
property owner.
4. If the designating body determines that the property owner has NOT made reasonable effort to comply,the designating body shall adopt a resolution
terminating the deduction. The designating body shall immediately mail a certified copy of the resolution to:(1)the property owner;(2)the county auditor;
and(3)the county assessor.
We have reviewed the CF-1 and find that:
lig the property owner IS in substantial compliance
❑ the property owner IS NOT in substantial compliance
❑ other(specify)
Reasons for the determination(attach additional sheets if necessary)
Signature of auth• e. me ber Date signed(month,day,year)
Attested by: --Jv "7*
Designating body
�R� JcvI S IA- CO.v 44 rti
If he property owner is found not to be in substantial compliance,the property owner shall receive the opportunity for a hearing.The following date and
time has been set aside for the purpose of considering compliance.
Time of hearing 0 AM E Date of hearing(month.day year) Location of hearing
�—❑ PM � ._. -- --- — — -- —
HEARING RESULTS(to be completed after the hearing)
❑ Approved ❑ Denied(see instruction 5 above)
Reasons for the determination(attach additional sheets if necessary)
i f
.�v. -........�.._"____-.�_. ._...�� Mom.
Signature of authorized member I Date signed(month,day year)
Attested by: Designating body
APPEAL RIGHTS[IC 6-1.1-12.1-5.9(e)J
A property owner whose deduction is denied by the designating body may appeal the designating body's decision by filing a complaint in the office of the
clerk of Circuit or Superior Court together with a bond conditioned topaythe costs of the appeal
if the appeal is determined against the property owner.
Page 2 of 2
•
COMPLIANCE WITH STATEMENT OF BENEFITS PRIVACY NOTICE FORM CF-1 I PP
PERSONAL PROPERTY This form contains confidential
' information pursuant to
State Form 51765(R6/12-21) IC 6-1.1-35-9 and IC 6-1.1-12.1-5.6. January 1, 2022
- = Prescribed by the Department of Local Government Finance
INSTRUCTIONS: 1. Property owners whose Statement of Benefits was approved must file this form with the local Designating Body to show the extent
to which there has been compliance with the Statement of Benefits. (IC 6-1.1-12.1-5.6)
2. This form must be filed with the Form 103-ERA Schedule of Deduction from Assessed Value between January 1 and May 16,2022,
unless a filing extension under IC 6-1.1-3.7 has been granted. A person who obtains a filing extension must file between
January 1 and the extended due date of each year.
3. With the approval of the designating body,compliance information for multiple projects may be consolidated on one(1)compliance(CF-1).
.ECTION 1 TAXPAYER INFORMATION
Name of taxpayer County
Heartland Automotive, LLC Tippecanoe
Address of taxpayer(number and street,city,state,and ZIP code) DLGF taxing district number
300 S. Warren Drive, Greencastle, IN 46135 67-008
Name of contact person Telephone number
Ritsuko Murakami Abrams (765 ) 653-4263
•ECTION 2 LOCATION AND DESCRIPTION OF PROPERTY
Name of designating body Resolution number Estimated start date(month,day,year)
Greencastle City Council 2017-16 09/25/2017
Location of property Actual start date(month,day,year)
300 S. Warren Drive, Greencastle, IN 46135
Description of new manufacturing equipment,or new research and development equipment,or new information technology Estimated completion date(month,day,year)
equipment,or new logistical distribution equipment to be acquired. 04/30/2018
New Equipment for Mfg Line, Including Toolings, Injection Molding Machine, Exterior Paint Actual completion date(month,day,year)
Robots, and Air.
•ECTION 3 EMPLOYEES AND SALARIES
EMPLOYEES AND SALARIES AS ESTIMATED ON SB-1 ACTUAL
Current number of employees 422 428
Salaries 16,333,406 18,269,903
Number of employees retained 422 422
Salaries 16,333,406 16,333,406
Number of additional employees 6
Salaries
1,936,497
•ECTION 4 COST AND VALUES
MANUFACTURING R&D EQUIPMENT LOGIST DIST IT EQUIPMENT
EQUIPMENT EQUIPMENT
COST ASSESSED ASSESSED ASSESSED ASSESSED
AS ESTIMATED ON SB-1 VALUE COST VALUE COST VALUE COST VALUE
Values before project
Plus: Values of proposed project 5,900,000
Less: Values of any property being replaced
Net values upon completion of project 5,900,000
ACTUAL ASSESSED ASSESSED ASSESSED ASSESSED
COST VALUE COST VALUE COST VALUE COST VALUE
Values before project
Plus: Values of proposed project 7,920,463 3,657,488
Less: Values of any property being replaced
Net values upon completion of project 7,920,463 3,657,488
NOTE:The COST of the property is confidential pursuant to IC 6-1.1-12.1-5.6(c).
•ECTION 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:
ECTION 6 TAXPAYER CERTIFICATION
I hereby certify that the representations in this statement are true.
Signature of authorized representative A Title Date signed(m rith,day,year)f//c(
Page 1 of 2
OPTIONAL: FOR USE BY A DESIGNATING BODY WHO ELECTS TO REVIEW THE COMPLIANCE WITH STATEMENT OF BENEFITS(FORM CF-1)
INSTRUCTIONS: (IC 6-1.1-12.1-5.9)
1. Within forty-five(95)days after receipt of this form,the designating body may determine whether or not the property owner has substantially complied with
the Statement of Benefits.
2. If the property owner is found NOT to be in substantial compliance, the designating body shall send the property owner written notice. The notice must
include the reasons for the determination,including the date;time and place of a hearing to be conducted by the designating body, if a notice is mailed to
a property owner,a copy of the written notice will be sent to the county assessor and the county auditor.
3. Based on the information presented at the hearing,the designating body shall determine whether or not the property owner has made reasonable effort to
substantially comply with the Statement of Benefits and whether any failure to substantially comply was caused by factors beyond the control of the
property owner.
4. If the designating body determines that the property owner has NOT made reasonable effort to comply,the designating body shall adopt a resolution
terminating the deduction. The designating body shall immediately mail a certified copy of the resolution to:(1)the property owner;(2)the county auditor;
and(3)the county assessor.
We have reviewed the CF-1 and find that: I
Efl.the property owner IS in substantial compliance
❑ the property owner IS NOT in substantial compliance
❑ other(specify)
Reasons for the determination(attach additional sheets if necessary)
Signature of auth• a member Date signed(month,day,year)
`(// .Tv ly ?* 2 o2Z
Attested by: Designating body
'- _. �/L� NCv}S IL Co Moot 0Ai Cov;vjjL
If he property owner is found not to be in substantial compliance,the property owner shall receive the opportunity for a hearing.The following date and
i time has been set aside for the purpose of considering compliance.
Time of hearing ❑AM i Date of hearing(month.day,year) Location of hearing — '— —
HEARING RESULTS(to be completed after the hearing)
❑ Approved ❑ Denied(see instruction 5 above)
Reasons for the determination(attach additional sheets if necessary) — ---
Signature of authorized member 1 Date signed(month,day,year)
Attested by: Designating body — —
APPEAL RIGHTS IIC 6-1.1-12.1-5.9(e)1
A property owner whose deduction is denied by the designating body may appeal the designating body's decision by filing a complaint in the office of the
clerk of Circuit or Superior Court together with a bond conditioned to pay the costs of the appeal if the appeal is determined against the property owner.
Page 2 of 2
COMPLIANCE WITH STATEMENT OF BENEFITS PRIVACY NOTICE FORM CF-1 /PP j
PERSONAL PROPERTY This form contains confidential
r ,. information pursuant to State Form 51765(R6/12-21) IC 6-1.1-35-9 and IC 6-1.1-12.1-5.6. January 1, 2022
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: 1. Property owners whose Statement of Benefits was approved must file this form with the local Designating Body to show the extent
to which there has been compliance with the Statement of Benefits. (IC 6-1.1-12.1-5.6)
2. This form must be filed with the Form 103-ERA Schedule of Deduction from Assessed Value between January 1 and May 16, 2022,
unless a filing extension under IC 6-1.1-3.7 has been granted. A person who obtains a filing extension must file between
January 1 and the extended due date of each year.
3. With the approval of the designating body,compliance information for multiple projects may be consolidated on one(1)compliance(CF-1).
.ECTION 1 TAXPAYER INFORMATION
Name of taxpayer County
Heartland Automotive, LLC Tippecanoe
Address of taxpayer(number and street,city,state,and ZIP code) DLGF taxing district number
300 S. Warren Drive, Greencastle, IN 46135 67-008
Name of contact person Telephone number
Ritsuko Murakami Abrams ( 765 ) 653-4263
ECTION 2 LOCATION AND DESCRIPTION OF PROPERTY
Name of designating body Resolution number Estimated start date(month,day,year)
Greencastle City Council 2018-16 12/3/2018
Location of property Actual start date(month,day,year)
300 S. Warren Drive, Greencastle, IN 46135
Description of new manufacturing equipment,or new research and development equipment,or new information technology Estimated completion date(month,day,year)
equipment,or new logistical distribution equipment to be acquired. 04/28/2019
Door Folding machine, Vacuum Foaming Machine, Door Cut Machine, Headliner Folding Actual completion date(month,day,year)
Machine
.ECTION 3 EMPLOYEES AND SALARIES
EMPLOYEES AND SALARIES AS ESTIMATED ON SBA ACTUAL
Current number of employees 455 428
Salaries 15,940,246 18,269,903
Number of employees retained 423 423
Salaries 15,174,806 15,174,806
Number of additional employees 32 5
Salaries 765,440 3,095,097
.ECTION 4 COST AND VALUES
MANUFACTURING R&D EQUIPMENT LOGIST DIST IT EQUIPMENT
EQUIPMENT EQUIPMENT
COST ASSESSED ASSESSED ASSESSED ASSESSED
AS ESTIMATED ON SB-1 VALUE COST VALUE COST VALUE COST VALUE
Values before project
Plus: Values of proposed project 4,576,337
Less: Values of any property being replaced
Net values upon completion of project 4,576,337
ACTUAL ASSESSED ASSESSED ASSESSED ASSESSED
COST VALUE COST VALUE COST VALUE COST VALUE
Values before project
Plus: Values of proposed project 5,216,789 2,087,516
Less: Values of any property being replaced
Net values upon completion of project 5,216,789 2,087,516
NOTE:The COST of the property is confidential pursuant to IC 6-1.1-12.1-5.6(c).
.ECTION 5 WASTE CONVERTED AND OTHER BENEFITS PROMISED BY THE TAXPAYER
WASTE CONVERTED AND OTHER BENEFITS AS ESTIMATED ON SBA ACTUAL
Amount of solid waste converted
Amount of hazardous waste converted
Other benefits:
.ECTION 6 TAXPAYER CERTIFICATION
I hereby certify that the representations in this statement are true.
Signature of authorized representative Title Date finned month,day,year)
_up
U Page 1 of 2
OPTIONAL: FOR USE BY A DESIGNATING BODY WHO ELECTS TO REVIEW THE COMPLIANCE WITH STATEMENT OF BENEFITS(FORM CF-1)
INSTRUCTIONS: (IC 6-1.1-12.1-5.9)
1. Within forty-five(45)days after receipt of this form,the designating body may determine whether or not the property owner has substantially complied with
the Statement of Benefits.
2. If the property owner is found NOT to be in substantial compliance, the designating body shall send the property owner written notice. The notice must
include the reasons for the determination,including the date, time and place of a hearing to be conducted by the designating body.If a notice is mailed to
a property owner,a copy of the written notice will be sent to the county assessor and the county auditor.
3. Based on the information presented at the hearing,the designating body shall determine whether or not the property owner has made reasonable effort to
substantially comply with the Statement of Benefits and whether any failure to substantially comply was caused by factors beyond the control of the
property owner.
4. If the designating body determines that the property owner has NOT made reasonable effort to comply,the designating body shall adopt a resolution
terminating the deduction. The designating body shall immediately mail a certified copy of the resolution to:(1)the property owner;(2)the county auditor'
and(3)the county assessor.
We have reviewed the CF-1 and find that:
the property owner IS in substantial compliance
D the property owner IS NOT in substantial compliance
❑ other(specify)
Reasons for the determination(attach additional sheets if necessary)
Signature of auth. ' e' me ber , Date signed(month,day,year)
4/4
Attested by. Designating body
%wet '0/ � j�.. ev2� ". ais4&k COCO41. vnJ CociOA./C _
If he property owner is found not to be in substantial compliance,the property owner shall receive the opportunity for a hearing.The following date and
I time has been set aside for the purpose of considering compliance.
Time of hearing ❑AM Date of hearing(month.day,year) Location of hearing
❑ PM I
HEARING RESULTS(to be completed after the hearing)
0 Approved 0 Denied(see instruction 5 above)Reasons for the determination(attach additional sheets if necessary)
--
Signature of authorized member Date signed(month,day,year)
Attested by: _ Designating body —
APPEAL RIGHTS[IC 6-1.1-12.1-5.9(e)]
A property owner whose deduction is denied by the designating body may appeal the designating body's decision by filing a complaint in the office of the
clerk of Circuit or Superior Court together with a bond conditioned to pay the costs of the appeal if the appeal is determined against the property owner.
Page 2 of 2