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STATEMENT OF BENEFITS <br />PERSONA/_ PROPERTY <br />as State Form 51764 (R 11-06) Pl2[ilAGY AfCi1°lCE —� <br />' Prescribed by the Department of Local Government Finance <br />The cost and any spaces indhddual's <br />salary v farrnation is conflidential; the <br />balance ofths filing public recd <br />IC 6.1.1- 12.1,5.1 (c and d . <br />iN3TRUC7IaN5: <br />1. This statement must be submitted to the body designating the Economic Revitalization Area prior to the public hearing if the designating body requires <br />information from the applicant in making its decision about whether to designate an 1 conomic Revitalization Area. Otherwise this statement must be subroiffed <br />to the designating body BEFARE a person installs the new manufacturing equipment andlor research and development equipment, andlor logistical distribution <br />equipment andlor information technology equipment For which the person wishes to claim a deduction, `projects' planned or committed to after July 1, 1987, <br />and areas designated after July 7, 1987, require a STATEMENT OF BENEFITS. (IC 6-1.7 -12.1) <br />2. Approval of the designating body (City Council, Tbwn Board, County Council, etc.) must be obtained prior to installation of the new manufacturing equipment <br />and/or research and development equipment andlor logistical distribution equipment and/or information technology equipment, BEFORE a deduction may <br />be approved <br />3, To obtain a deduction, a person must file s ceftitied deduction schedule with the parsons personal property return on a certMed deduction schedule (Form <br />103 -ERA) with the township assessor of the township where the property is situated. The 103 -ERA must be filed between March i and May 15 of the <br />assessment year in which new manufacturing equipment and/or research and development equipment andlor logistical distribution equipment and /or <br />information technology equipment is Installed and fully functional, unless a filing extension has been cbtalr? r . A person who obtains a thing extension must <br />file the form between March 7 and the extended due date of that year. <br />4. Property owners whose Statement of Benefits was approved after June 30, 1991, must submit Form CF-1 / PP annually to show compliance with the <br />Statement of Benefits. <br />5. The schedules established under IC 6- 1.142,14.5(d) and (e) apply to equipment installed after March 1, 2001. For equipment installed prior to March 2, <br />2001, the schedules and statutes in effect at the Gma shad continue to apply. (IC 6.7.1 -92. t- 4.5(fJ and (g)) <br />Name ofPaY� <br />Patterson Logiistes Services, Inc. <br />Address oftDpayer (number and scree; city, state, and ZIPcWe) <br />1081 Mendota Heights Road, St.Paul, MN 55120 <br />ham* of comet person Telephone number <br />Sean Muniz (651) 686 -1802 <br />��SECTION 2 • • ■ ■ • • ••••• • •y• <br />Name of destgnatin9 body Resolution number ts} <br />city of South Bend <br />Locstmn of prorty County DLGF tapng dLstrlct number <br />7055 Cleveland Road St. ,Joseph <br />Description of manufacturing equipment and/or research and development equipment ESTIMATED <br />and/or logistical distribution equipment andlor information technology equipment <br />(use addiflonal sheets Ifnecessary) START DATE COMPLETION DATE <br />Racking and conveyor equipment, server equipment, Manufacturing Equipment <br />cabling, and security equipment. R & la Equipment <br />Logist Dist Equipment 07/0112010 10/0112010 <br />IT Equtpm 07/01/2010 10/01/2010 <br />• lug • •••• PROJECT <br />Current number Salaries $27, 040 avg. ttumb•rrafaioed 50 Sarert- $27,040 avg. Numb•radditiona150 S rl- <br />60 d= $20,800 avg <br />per person per person gar person <br />• <br />NOTE: Pursuant to IC 6-41- 121-5.1 (d) (2) the �E OF PM 1FUNG R & D EQUIPMENT EQ UEPN DI T ST rr EQUIPMENT <br />COST of the property is confidential. COST I ASSESSED COST A$$ES5EU COST AS$ES$M COST ASSESSM <br />VALUE VALUE VALUE VNWE <br />Current values <br />Plus estimated values of proposed project $8.6 mrllinr, ss.s rd1lio, $400.000 $400,000 <br />Less values of any property being replaced <br />Net esimated vatue8 upon'compledon of proj2ct $8.6 minion $5.6 4 11ion $400,000 $400, 064 <br />• ■ • •t <br />Estimated solid waste converted (pounds) NIA 1=stirnated hazard,,, waste c aTded (pounds) Wk <br />Other banefits: <br />• MOWN 111, <br />I hereby certify that the representations in this statement are true. <br />Sbpnature of T Dale ned ( , day. yead iahio <br />