Bill No. 16-61 Personal Property Designating Tax Abatement for AM General, LLC

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Filed In Clork s office R STATEMENT OF BENEFITS f' FORM 58 -1 / PP PERSONAL PROPERTY State Form 61764 (R4111 -15) JUL i. � io {-c "� , v' • Prescribed by the Department of Local Government Financ L U 1 U PRIVACY NOTICE A information concerning the cost i�REiiViAI i of he property and specific salaries paid FOWLER to ndividual employees by the pro pel! CITYCLERK, SOUTH BEND, ! o er is coMtdenual per IC ti -1.1- 12.1 -s:iY INSTRUCTIONS 7. This statement must be submitted to the body designating the Economic Revitalization Area prior to the public hearing If the designating body requires information from the applicant In making its decision about whether to designate an Economic Rew7a//zellon Area. Otherwise Als statement must be submitted to the designating body BEFORE a person Installs the new manufacturing equipment and/or research and development equipment, and/or logistical distribution equipment antl(or Information technology equipment for which the person wishes to claim a deduction. 2. The statement of benefits form must be submitted to the designating body and the area designated an economic revitalization area before the Installation ofqualitying abatable equipment for which the person desires to claim a deduction I To obtain a deduction, a person must file a certified deduction schedule with the persons personal property return on a certified deduction schedule (Form 103 -ERA) with the township assessor of the township where the property is situated or with the county assessorif there Is no township assessor for the township. The 103 -ERA must be filed between January 1 and May 15 of the assessment year in which new manufacturing equipment and/or research and development equipment and/r logistical distribution equipment and/or information technology equipment Js Installed and fully functlonal, unless a filing extension has been obtained A person who obtains a f/fim9 extension must fie the form between, January 1 and the extended date date of that year Property owners whose Statement of Benellts was approved, must submit Form CF 11PP annually to show compliance with the Statem ant of Benefits. (IC 6 ->.1- 12.1 -6.6) Fora Form S13-11PP that Is approved after June 30, 2013, the designating body is required to astahfish an abatement schedule for each deduction allowed. Fora Form SB- 11PPthat Is approved priorto July 1, 2013, the abatement schedule approved bythe designating body remains in effect (IC &1.1- 12.1 -17) LLC I Eric Swift. Manaaer. Lnaistirc At runt 105 N Niles Ave street, dIX state, and Bend,IN 4661 (574 ) .......1.,.1, - —%,w— rU1wyc rr till it: 2872-00 Location of propsny 5448 Dylan Dr, South Bend IN 46.628 County DLGF texing district number St. Joseph 009 Description of manufacturing equipment and /or research and development equipmant ESTIMATED and/or logistical distribution equipment and /or Information technology equipment. (Use additional sheets If necessary.) START DATE I COMPLETION DATE Manufacturing Equipment Pallet Racking, Fork Trucks, R & D Equipment Logist Dist Equipment 09/2016 12131/2016 IT Equipment 09/2016 12/31/2016 Curmnlnumber Salaries Number retained Saledea Numberaddiuonal Salaries 136 $40.78 123. 36.38 IMIN NOTE: Pursuant to iC 61.1- 1216.1 (d) (2) the MANUFACTURING EQUIPMENT R & D EQUIPMENT LOGIST DIST IT EQUIPMENT COST of the property is conftdentlal. COST ASSESSED E UIPMENT COS ASSESSED ASSESSED ASSESSED �S CDC COST VALUE VALUE Current values 631.008 1,444,50 227,269 Plus estimated values of proposed project 5,0 3,065,0 Less values of props bein replaced Net estimated values upon completion of roject 13.696.0(H 227.269 Estimated solid waste converted (pounds) Estimated hazardous waste converted (pounds) Olherbenauts: SECTION hereby : ertiy that the representation In this statement are tnme, S auth rep tive Date signed (month, dax year) `� / Prin name . sentaa" N t - Title Rk0iA & +1 " r — SP) 1) Page 1 *f2