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STATEMENT OF {BENEFITS <br />PERSONAL PROPERTY <br />61ete Farm 51784 (R 11.06) <br />Prescribed by the Department of Local Govemment <br />Filed In Clerk's Office <br />JUL -2 2010 <br />JOHN VOOFTE <br />CI" GL,-?1K, 80. BEND, IN. <br />FORM SR•1 i PIP <br />PRIVACY NOTICE <br />rno teat craft any tic In"ware <br />salary lrslormatlon fa aenndanul; the <br />balance of the tare� is pubNc record <br />INSTRUCTIONS: w 1C t:1.t•tz.i -5.i a and d . <br />I. This statement must be submitted to the body designating the Economic Revitalization Area prior to the public hearing y the designating body requires <br />kdLVM811on from the applicant In making Its decisfun about whether to designate an Economic Revitalization Area. Otherwise this statement must be submtted <br />to the designating body BEFORE a person installs the new manufacturing equipment and/or research and development equipment and/or logistclal distribution <br />equipment and/or Information teehnvfagy equipment for which the person wishes to claim a deduction. Projects' planned or committed to after Juiy 1, f987 <br />and areas designefed after July !, 1987 requlte s STATEMENT OF BENEFITS. <br />2, Approval ofthe designating body (Co Council, Town 900113, Ccunly Counck etc.) must be obtained prior to instaosticn of the new manufacturing equipment <br />and/or research and development equipment anWork9bdcal dlsfnbtWon squlpment and/or infomretion taehrrology equrpmenf, BEFORE a deduction may be approved <br />3. To obtain a deduction, a person must Rie a carliffed deduction schedule with the persons personal property 10(um on a oertrlled deduction schedule (Form <br />103 -ERA) wilh the township assessor or the township where the property is sffusted. The 103 -ERA must be Mad between March t and May 15 of the <br />assessment year In which new manulacfurfng equlPnenl and/or research and development equipment and/or logistical distribution equlpmant and /or <br />lnformallon lechnaiogy equipment Is induffed and fully fun AMI, unless a tying extension has been obtained. A person who obtains a filing axtenakn must <br />No the form between March f and the extanded dua date of that year, <br />4, Property owners whose Statement ofBenents was approved after June 30, 1991, must submit Form CF-! /PP annually to show compliance with the <br />Statement Of Benefits. (iC 8•f.1•!2 -5.5) <br />5. The schedules astabyshed under IC 0 -1. l- 12.1.9.5(4) and (a) apply to equipment installed after March 1, 2001, for equipment installed prior to March 2, <br />2001, the schedules and statutes in effact at ft time shay continue to eppfy. (it; 6- 1.1 -12. !•4 5(0 and (g)) <br />Name o! taxpayer <br />McCormksis and Cote any, Iris. <br />Addrese of taxpayer (rrambar and arreer, CHX ef&I& and ZIF code) <br />1S Lovetan Carole, Sparks, MD 21152 <br />Noma Of Contact pamon <br />Deidre Cassidy <br />ss a <br />Name of deaigrtadng body <br />.LOCatian a1 properly <br />3425 West Lathrop Drive, South Bend, IN st. <br />Descrlptlon of manufacturing equipment and /or research end development equipment <br />and/or foogglstical distrtbutlorr equipment and/or infonmatfon technology equipment, <br />(use addtYiwmal sheets it necessary) <br />Additional manufacturing equipment amounting to <br />approximately $690,000 will be acquired including fork <br />lifts, coolers, racking, computers and furniture and <br />ilxtures. <br />6,288,988 <br />NOTE: pursuant to Ic &4.1- 42.1 s.1 (d) (z) the <br />COST of the property is conlidendal, C <br />CO6T. <br />Current values <br />I°lus estimated <br />Less values of <br />Net estimated s <br />Estimated solid waste cmvsrted (pounds) <br />Other beneit —s- <br />a number <br />T71 -7381 <br />ROMMian number (s) <br />DLGF taxing district nwnber <br />6,288,988 <br />R A D EQUIPMENT LO <br />EL <br />COST A9ME8.D COST <br />Estimated hazardous waste converted (pounds) <br />None with current project. Waste water facility previously built to treat H2O. <br />that the representations In this statement are true, <br />x5/30/2011 <br />05/30/2011 <br />05/30/2071 <br />05/30120'11 <br />;ale,i�ee�s <br />*177,247 <br />!T EQUIPMENT <br />Cm I Mg- E <br />0.00 <br />I Date 0 gnatyl <br />Director - S tate d, Local lax ' 1 4 <br />Manufacturing Equipment <br />R & n Equipment <br />E5TART <br />Logist Dist Equipment <br />IT Equiprr " <br />09/01/2010 <br />6,288,988 <br />R A D EQUIPMENT LO <br />EL <br />COST A9ME8.D COST <br />Estimated hazardous waste converted (pounds) <br />None with current project. Waste water facility previously built to treat H2O. <br />that the representations In this statement are true, <br />x5/30/2011 <br />05/30/2011 <br />05/30/2071 <br />05/30120'11 <br />;ale,i�ee�s <br />*177,247 <br />!T EQUIPMENT <br />Cm I Mg- E <br />0.00 <br />I Date 0 gnatyl <br />Director - S tate d, Local lax ' 1 4 <br />