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STATEMENT OF BENEFITS F ®RBI SS -1 1 PP <br />PERSONAL PROPERTY �- <br />4r State Form 51784 (R 11-06) PRIVACY NOTICE <br />Prescribed by the Department of Local Government Finance <br />The cost and any specific individual's <br />salary information confidential; the <br />balance of the fill �rttgp Is slit record <br />er IC 6-1.1- 12.1 -5.1 c and d <br />INSTRUCTIONS: <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 ,Economic Revitalization Area. Otherwise this statement must be submitted <br />to the designating body BEFORE a person installs the new manufacturing equipment and/or research and development equipment, and/or logistical distribution <br />equipment and/or 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 1, 1987, require a STATEMENT OF BENEFITS. (IC 6 -1.1 -12.1) <br />2. Approval of the designating body (City Council, Town Board, County Council, etc.) must be obtained prior to installation of the new manufacturing equipment <br />and /or research and development equipment and/or 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 a certified deduction schedule with the person's personal property Tatum on a certified 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 and/or logistical distribution equipment and/or <br />information technology equipment is installed and fully functional, unless a riling extension has been obtained. A person who obtains a filing extension must <br />rile the form between March 1 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. (IC <br />5. The schedules established under IC 6 -1.1- 12.1- 4.5(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 time shall continue to apply. (IC &1. 1-12.1-4.5(o and (g)) <br />Name of taxpayer <br />South Bend Gear, LLC <br />Address of taxpayer (number and street city, state, and ZIP Code) r t' p N r5 I <br />3849 Showerlux Drive, South Bend, Indiana 4662.8 f �S I <br />Name of contact person Telephone number <br />Stan Blenke JOHN VOORDE (574) 234 -4116 <br />Name of designating body 1 Resolution number (s) <br />South Bend Common Council <br />Location of property County DLGF taxing district number <br />3849 Showerlux Drive, South Bend, Indiana 46628 St. Joseph 71 -009 <br />Description of manufacturing equipment and/or research and development equipment ESTIMATED <br />and/or logistical distribution equipment and/or information technology equipment. <br />(use additional sheets if necessary) START DATE COMPLETION DATE <br />See attached 2 sheets. Manufacturing Equipment 07/01/2011 <br />R & D Equipment <br />Logist Dist Equipment <br />IT Equipment <br />• ESTIMATE OF • e SAL4R.IES�4§ RES; ULTOF PROPOSED ••• <br />Current number Salaries Number retained Salaries Number additional Salaries <br />0 10.00 0 1 0.00 12 550,000.00 <br />• <br />w TOTAL COSTAND <br />• -o•• a ••s <br />NOTE. Pursuant to jr, 6 -1.1- 12.1 -5,1 (d) (2) the <br />MANUFACTURING <br />EQUIPMENT <br />R g 1] EQUIPMENT <br />LOGIST DIST (T EQUIPMENT <br />EQUIPMENT <br />COST <br />ASSESSED <br />COST <br />ASSESSED <br />COST <br />ASSESSED <br />COST <br />ASSESSED <br />COST of the property is confidential. <br />VALUE <br />VALUE <br />VALUE <br />VALUE <br />Current values <br />0.00 <br />o.Do <br />Plus estimated values of proposed project <br />15.600,000.00 <br />6,240,000.00 <br />Less values of any property being replaced <br />0.00 <br />0.00 <br />Net estimated values upon completion of project I 15 >60o,000.00 6,240,000.00 <br />o • a o• <br />-e a: <br />Estimated solid waste converted (pounds) <br />Estimated hazardous waste converted (pounds) <br />Other benefits; <br />Total employees to be hired is estimated to be 26 by the completion date, <br />that the representations in this statement are true. <br />Signature of authorized representative ;1 E We Date signed (month, day, year] <br />Manager 1 01/28/2011 <br />