Form Cf-1/pp (State Form 51765) - Compliance With Statement Of Benefits Personal Property
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1
2COMPLIANCE WITH STATEMENT OF BENEFITS
FORM CF-1 / PP
PERSONAL PROPERTY
State Form 51765 (R / 1-06)
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 March 1, and May 15, of each
year, unless a filing extension under IC 6-1.1-3.7 has been granted. A person who obtains a filing extension must file between
March 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).
SECTION 1
TAXPAYER INFORMATION
Name of taxpayer
Address of taxpayer (number and street, city, state, and ZIP code)
Name of contact person
T elephone number
(
)
SECTION 2
LOCATION AND DESCRIPTION OF PROPERTY
Name of designating body
Resolution number
Location of property
County
DLGF taxing district number
Description of new manufacturing equipment, or new research and development equipment, or new information technology
Estimated starting date (month, day, year)
equipment, or new logistical distribution equipment to be acquired.
Estimated 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
MANUFACTURING
LOGIST DIST
IT EQUIPMENT
R & D EQUIPMENT
EQUIPMENT
EQUIPMENT
ASSESSED
ASSESSED
ASSESSED
ASSESSED
AS ESTIMATED ON SB-1
COST
COST
COST
COST
VALUE
VALUE
VALUE
VALUE
Values before project
Plus: Values of proposed project
Less: Values of any property being replaced
Net values upon completion of project
ASSESSED
ASSESSED
ASSESSED
ASSESSED
ACTUAL
COST
COST
COST
COST
VALUE
VALUE
VALUE
VALUE
Values before project
Plus: Values of proposed project
Less: Values of any property being replaced
Net values upon completion of project
NOTE: The COST of the property is confidential pursuant to IC 6-1.1-12.1-5.6 (d).
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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