HomeMy Public PortalAbout12 - 2023-12 - AFFIRMING HEARTLAND AUTO OF COMPLIANCE WITH STMT OF BENEFITS RESOLUTION NO. 2023 - 12
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 15, 2023:
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
13th day of July 2023.
COMMON COUNCIL OF THE CITY OF GREE CASTTALEr , IND ANA
ad.Cody ert Mark mer
sell Harvey Stacie L on
vid Murray s Veronica nl
Darrel Thomas
Approved and signed by me this 13th day of July 2023 at `6‘, p. 'clock.
is . ory, Jr., o
ATTE :
Ly R. Dunbar, Clerk-Treasurer
PRIVACY NOTICE FORM CF-I !PP
,' COMPLIANCE WITH STATEMENT OF BENEFITS This fomi contains confidential
. n.1- PERSONAL PROPERTY information pursuant to 2Q 23 Pa 20 24
• PI StateForm 51765(R7/12-22} IC 6 1.1-35 9 and IC 61.1-12.1 5.6. , y
-may-;`" Prescribed by the Department of Local Government Finance
INSTRUCTIONS: 1. Properly 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 15,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 form(CF-1).
•ECTION 1 TAXPAYER INFORMATION
Name of Taxpayer County
Heartland Automotive, LLC Putnam _
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 Email Address
Ritsuko Murakami Abrams (765)653-4263
•ECTION 2 LOCATION AND DESCRIPTION OF PROPERTY
Name of Designating Body Resolution Number Estimated State 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,new research and development equipment,new information technology equipment,or Estimated Completion Date(month,day,year)
new logistical distribution equipment to be acquired.
2 Injection Molding machines, 1 slush Molding Machine, 2 Interior Paint Booths Actual Completion Date(month,day,year)
1113
•ECTION 3 EMPLOYEES AND SALARIES
EMPLOYEES AND SALARIES AS ESTIMATED ON SB-1 ACTUAL
Current Number of Employees 405 426
Salaries 14,313,725 22,222,922
Number of Employees Retained 405 405
Salaries 14,313,725 21,127,426
Number of Additional Employees _ 21
Salaries 1 095 496
•ECTION 4 COST AND VALUES
MANUFACTURING RESEARCH& LOGISTICAL DISTRIBUTION IT EQUIPMENT
EQUIPMENT DEVELOPMENTEQUIPNENT EQUIPMENT
ASSESSED ASSESSED ASSESSED ASSESSED
AS ESTIMATED ON SB-1 COST VALUE COST VALUE COST VALUE COST VALUE
Values Before Project $ $ $ S $ $ $ $
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 COST ASSESSED COST ASSESSED COST ASSESSED COST ASSESSED
VALUE VALUE VALUE VALUE
Values Before Project $ $ $ $ $ $ $ $
Plus:Values of Proposed Project $ 5,255,015 $ 980,004 $ $ $ $ 5 $
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 representations in this statement are true.
Signature of Authorized Repre n 've i Title �'� _ ,/� Date Si (monj�' day,year)
r l� fl G/t(J( �/ 6 ! Z�
Page 1 of 2 `
OPTIONAL: FOR USE BYA 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 and 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, then 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
❑ the property owner IS NOT in substantial compliance
❑ other(specify)
Reasons for the determination(attach additional sheets if necessary)
Signa o uthgrized me Date signed(month,day,year)
u.�/r 7 113 1 Z0-3
A ested b • Designating body
�LLG GP`cvOiC C.C3irvIVVIM1C tx L.
If t e 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(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)
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
PRIVACY NOTICE ' :FORM CF-I [PP
�,..g. COMPLIANCE WITH STATEMENT OF BENEFITS This form contains confidential
} PERSONAL PROPERTY information pursuant to 20 23 Pay 24
State Form 51765(R7/12-22) IC 6-1.1-35-9 and IC 6-1.1-12.1-5.6. 20_
,r,. Prescribed by the Department of Local Government Finance
INSTRUCTIONS: 1. Properly 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 15,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 form(CF-1).
•ECTION 1 TAXPAYER INFORMATION
Name of Taxpayer County
Heartland Automotive, LLC Putnam
Address of Taxpayer(number and street,city,state,and ZIP code) D LGF Taxing District Number
300 S. Warren Drive, Greencastle, IN 46135 67-008
Name of Contact Person Telephone Number Email Address
Ritsuko Murakami Abrams (765 )653-4263
•ECTION 2 LOCATION AND DESCRIPTION OF PROPERTY
Name of Designating Body Resolution Number Estimated State 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,new research and development equipment,new information technology equipment,or Estimated Completion Date(month,day,year)
new logistical distribution equipment to be acquired. 1 2 1/2016
Headliner Stamping, Assembly, Tier Cut, Powder Slush, Apron Press, Rivet Actual Completion Date(month,day,year)
•ECTION 3 EMPLOYEES AND SALARIES
EMPLOYEES AND SALARIES AS ESTIMATED ON SB-1 ACTUAL
Current Number of Employees 389 426
Salaries 15,760,060 22,222,922
Number of Employees Retained 1405 405
Salaries 15,760,060 21,127,426 _
Number of Additional Employees 43 21
Salaries 1,148 160 1 095 496
•ECTION 4 COST AND VALUES
MANUFACTURING RESEARCH& LOGISTICAL DISTRIBUTION IT EQUIPMENT
EQUIPMENT DEVELOPMENTEQUFNENT EQUIPMENT
ASSESSED ASSESSED ASSESSED ASSESSED
AS ESTIMATED ON SB-1 COST VALUE COST VALUE COST VALUE COST VALUE
Values Before Project $ $ $ $ $ $ $ $
Plus:Values of Proposed Project $ 8,285,727 $ $ $ $ $ $ $
Less:Values of My Property Being Replaced $ $ IS IS $ $ $ $
'Net Values Upon Completion of Project $ 8,285,727 S IS $ $ $ $ $
ASSESSED ASSESSED ASSESSED ASSESSED
ACTUAL 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 $ $ IS $ $ $ $ $
Net Values Upon Completion of Project S 9,000,000 $ 3,780,000 $ $ $ $ IS $
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 l AS ESTIMATED ON SB-1 ACTUAL
Amount of Solid Waste Converted
Amount of Hazardous Waste Converted I I
Other Benefits:
•ECTION 6 TAXPAYER CERTIFICATION
I hereby certify that the representations i this statement are true.
Signature of Authorized Representative Title / f ) Datelgss 7 nth/day year)
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 and 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, then 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
❑ the property owner IS NOT in substantial compliance
❑ other(specify)
Reasons for the determination(attach additional sheets if necessary)
Signa o uthprized me Date signed(month,day,year)
? l +3 12-0'2_3
A ested b . Designating body
. GQ`ev•)(—SUE_ Cc3rvivvI Cot-)c jci L.
If t e 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(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)
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
PRIVACY NOTICE FORM'CF-11 PP
.7., COMPLIANCE WITH STATEMENT OF BENEFITS This form contains confidential
,1 PERSONAL PROPERTY Information pursuant to
State Form 51765(R7/12-22)
IC 6-1.1-35-9 and IC 6-1.1-12.1-5.6. 20 23 Pay 20 24
,,,: 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 15,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. tiVith the approval of the designating body,compliance information for multiple projects may be consolidated on one(1)compliance form(CF-1).
.ECTION'1 TAXPAYER INFORMATION
Name of Taxpayer County
Heartland Automotive, LLC Putnam
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 Email Address
Ritsuko Murakami Abrams (765 )653-4263
•ECTION 2 LOCATION AND DESCRIPTION OF PROPERTY
Name of Designating Body Resolution Number Estimated State 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,new research and development equipment,new information technology equipment,or Estimated Completion Date(month,day,year)
new logistical distribution equipment to be acquired. 04/30/2018
New Equip for Mfg Line,Incl Toolings,lnjection Molding Mach,Ext Paint Robot& Actual Completion Date(month,day,year)
.ECT10N 3 EMPLOYEES AND SALARIES
EMPLOYEES AND SALARIES AS ESTIMATED ON SB-1 ACTUAL
Current Number of Employees 422 426
Salaries [16,333,406 22,222,922
Number of Employees Retained 1422 422
Salaries 116,333,406 22,014,256
Number of Additional Employees .4
Salaries 208 666
•ECTION 4 COST AND VALUES
MANUFACTURING RESEARCH& LOGISTICAL DISTRIBUTION IT EQUIPMENT
EQUIPMENT DEVELOPMENTEQUIPNENT EQUIPMENT
ASSESSED ASSESSED ASSESSED ASSESSED
AS ESTIMATED ON SB-1 COST VALUE COST VALUE COST VALUE COST VALUE
Values Before Project $ $ $ $ $ $ $ $
Plus:Values of Proposed Project $ 5,900,000 $ IS $ $ $ $ $
Less:Values of Any Property Being Replaced $ $ IS $ $ $ $ $
Net Values Upon Completion of Project $ 5,900,000 $ $ $ $ $ S $
ASSESSED ASSESSED ASSESSED ASSESSED
ACTUAL 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 $ $ $ $ $ s
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 /
Title _ ^ Date Sign (moot •�dayr year)
'VIP
fjV� r� 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 and 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,then 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
❑ the property owner IS NOT in substantial compliance
❑ other(specify)
Reasons for the determination(attach additional sheets if necessary)
Signa o uthprized me Date signed(month,day,year)
ct /�� 7 Il3I Zo'Z:A
A ested b • Designating body
/t V
cc %�----• &P`cv►iCAS-tiE. C[3rvItMc.1 CtsUt.><1 L-
If e 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 D AM 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)
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
PRIVACY NOTICE FORM CF-4/PP'.
.r$"•-- \ COMPLIANCE WITH STATEMENT OF BENEFITS This form contains confidential
, PERSONAL PROPERTY information pursuant to
State Form 51765(R7/12-22) IC 6-1.1-35-9 and IC 6-1.1-12.1-5.6. 2023 Pay 20 24
,,• 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 15,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 form(CF-1).
-ECTION 1 TAXPAYER INFORMATION
Name of Taxpayer County
Heartland Automotive, LLC Putnam
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 Email Address
Ritsuko Murakami Abrams c 765)653-4263
.ECTION 2 LOCATION AND DESCRIPTION OF PROPERTY
Name of Designating Body Resolution Number Estimated State Date(month,day,year)
Greencastle City Council 2018-16 12/3/2018
Location of Property i Actual Start Date(month,day,year)
300 S. Warren Drive, Greencastle, IN 46135
Description of new manufacturing equipment,new research and development equipment,new information technology equipment,or Estimated Completion Date(month,day,year)
new logistical distribution equipment to be acquired. 04/28/2019
Door Folding Mach,Vacuum Foaming Mach,Door Cut Mach,Headliner Foldin% Actual Completion Date(month,day,year)
•ECTION 3 EMPLOYEES AND SALARIES
EMPLOYEES AND SALARIES AS ESTIMATED ON SB-1 ACTUAL
Current Number of Employees 455 426
Salaries 15,940,246 22,222,922 ,
Number of Employees Retained 423 423
Salaries 115,174,806 22,066,422
Number of Additional Employees 132 3
Salaries 765 440 156 500
•ECTION 4 COST AND VALUES
MANUFACTURING RESEARCH& LOGISTICALDISTRIBUfION IT EQUIPMENT
EQUIPMENT DEVELOPMENTEQJIP1VENT EQUIPMENT
ASSESSED ASSESSED ASSESSED ASSESSED
AS ESTIMATED ON SB•1 COST VALUE COST I VALUE COST VALUE COST I VALUE
Values Before Project $ S $ $ $ $ $ $
Plus:Values of Proposed Project $ 4,576,337 S $ $ $ $ IS $
Less:Values of Any Property Being Replaced S $ $ $ $ $ I5 $
Net Values Upon Completion of Project $ 4,576,337 $ $ $ $ $ IS $
ASSESSED ASSESSED ASSESSED ASSESSED
ACTUAL 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 6-1,1-12.1-6.6(c).
•ECTION 5 WASTE CONVERTED AND OTHER BENEFITS PROMISED BY THE TAXPAYER
WASTE CONVERTED AND OTHER BENEFITS I 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 ✓ Title Date Si (m nth,day,year)
Page 1 of 2
OPTIONAL: FOR USE BYA 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 and 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, then the designating body shall adopt a resolution
terminating the deduction. The designating body shall immediately mail a certied 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
❑ the property owner IS NOT in substantial compliance
❑ other(specify)
Reasons for the determination(attach additional sheets if necessary)
Signs o uthprized me b Date signed(month,day,year)
��/' 7 1 13 1202.3
A ested b • Designating body
- �---- f i?`t�►iC 4A Cc.uwlvw►a CcsU 1 L-
If t e 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(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)
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 2of2