HomeMy WebLinkAboutAxmann Real Property GbRNS J'RUG TION$:
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COMPLIANC~ WITH STATEMENT OF BENEFITL
I ~-ORM
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L Pro~e~y owne~ w,hose Statement Of Benefit~ was approved e~et June 30 J~g.~ ~.fil% ~,~;s (=~:7 ~¢~ {~e:.~gun?/
local Oe~gne~ng ~ody o show t.he ex ~nt to whlc,h, there has been com~;ianCp:~:~ '~h~S~ ~[ ~.~,?~. ' (Tins
ta pro~e~y located in e regde~ge.'ly disobeyed ~ree). (IC 6-L f-~2. ~-5.~)
2. If the deduction applies to Rag Estate a~d Improvements. ~hen this form mus~ be Ned wRh :h e i: :' g deduction epp;;ce~on
annual y within six~/ (60) days a~er the end of each year in which ~he deduction is applicable. . , '
3. F~r Ne~,~ Manufectu~n~ Equipment. t,hls form must be Eled with Fo~ ~22 E,R~P b e~we en Marc,h ~ and May f ~
Addr.~ss o ! taxpayer (stye et and numbe4 city. state and ZIP code)
q~50 ~t~ ~(ddle ~o~d JcFPcrsoavt'll~
Cifu oF dcfl~,'~onv~ ~ Clfq Co~nc(J qq
.o~;,:~,~/q~O ~L~ ~(ddle ~d u ico~=,/ Clark
Conskuc?ion oF nc~ &~,5oo sq.F~. Iqd~skri~{ czr~o~se q/qq
10/1~'/00 " "
Sel~:i, es
Se:eries
s: ~,'~!ues or ¢.r:oo~d ~rqect , I. lO0. 000 [ ~q f¢¢ 500 I I
s: Values of an'/property being replaced J
values uocn completion or' proiect I, {00, OCOt ~q~. 500 1 ~ ...... ," "':'~
~~~~~:~:F-fCSst':..~:~'=: AssessedValue [:.7~ ~::~[::;:~:~ Ass~ssedVa[ue i.': ::.,.:~os,.v::.:~.::,:.. ~ssessedValu~
v clues upon c~mplet[on o~ pro[ac[ Il, ~O~.q~J ~, ~00 J
~--¢'?~:) ~' l hereby ce.,'tibt that Ina reoresemations in this s ~ _m.n. a,. l u.
i '~t~e joa~a s:gned (mo.. da./. Ft'.)
/." x,4~ .' .~ ~/~ ~./,.-,
~'$1-RU.C~70~$: (7C$~../.12.1~$.~) . .
~.. l,' th~ prop~.~/ ow,~eris fo~,.5...._ - ~' ~-~t cwn~r has su~s~an~,ly c=~;~ w;t~
an~ (3) t,~e Stat. R~= ~ -~ ~,,e ~es~na~. ~_~,' v ~,~4~erhas NO~---~ - ...-~e reeson~bl.
have re'ne.wed ~he CF-1 and find tha~: .... / cwneC {2} t,~e Coun~,~'~,°n
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