K-2 - City TIF Indebtedness Certification 2021

TIF INDEBTEDNESS NOT PREVIOUSLY CERTIFIED ELIGIBLE FOR TAX COLLECTIONS NEXT FISCAL YEAR City: Tiffin County: Johnson Urban Renewal Area Name: Tiffin Urban Renewal Area Urban Renewal Area Number: 52009 (Use five-digit Area Number Assigned by the County Auditor) <table> <tr> <th>Individual TIF Indebtedness Type/Description/Details:</th> <th>Date Approved*:</th> <th>Total Amount:</th> </tr> <tr> <td>1. MD Real Estate (Tiffin Family Care) Rebate/Economic Development Grant<br>Rebate not to exceed $87,000, beginning June 1, 2021 and continuing to and including June 1, 2025</td> <td>1/5/2021</td> <td>87,000</td> </tr> </table> [X] 'X' this box if a rebate agreement. List administrative details on lines above. 2. ____________________________________________ ____________________ ____________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ [ ] 'X' this box if a rebate agreement. List administrative details on lines above. 3. ____________________________________________ ____________________ ____________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ [ ] 'X' this box if a rebate agreement. List administrative details on lines above. 4. ____________________________________________ ____________________ ____________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ [ ] 'X' this box if a rebate agreement. List administrative details on lines above. 5. ____________________________________________ ____________________ ____________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ [ ] 'X' this box if a rebate agreement. List administrative details on lines above. If more indebtedness entry lines are needed continue to Form 1.1 Page 2. Total For City TIF Form 1.1 Page 1: 87,000 * "Date Approved" is the date that the local governing body initially approved the TIF indebtedness.