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STATEMENT OF BENEFITS
<br />PERSONAL PROPERTY FORM sg -1 1 PP
<br />State Form 51764 (R 11 -06)
<br />Prescribed by the Department of Local Government Finance ffbalance RIVACY NOTICE
<br />and any speck individual's
<br />ormation is confidential; the
<br />of thfiling public record
<br />INSTRUCTIONS: 1.1- 12.1 -5.1 c and {d ,
<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 Juiy 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 return 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 1 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 filing extension has been obtained. A person who obtains a filing exfension must
<br />file 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 &-1. f- 12.1 -5.6)
<br />5. The schedules established under IC 6 -1.1- 12,1- 4.5(d) and (e) apply t •Zh f10 For equipment installed prior to March 2,
<br />2001, the schedules and statutes in effect at the time shall continue t 1 1.1- .1 -4.5 fj,and,(g))
<br />Name of taxpayer
<br />Hoosier Tank and Manufacturing incorporated
<br />Address of taxpayer (number and street, city, state, and ZIP code) W W
<br />1710 North Sheridan Street South Bend, IN 46628
<br />Name of contact person J684 Telephone number
<br />Sue A. Kinnucan CITY CLERK, C UTH END, IN (574) 232 -8368
<br />Name of designating body Resolution number (s)
<br />Common Council of South Bend
<br />Location of property County DLGF taxing district number
<br />1710 North Sheridan Street St Joseph
<br />Description of manufacturing equipment and /or research and development equipment ESTIMATED
<br />logistical distribution equipment and /or information technology equipment.
<br />(use additional sheets if necessary) START DATE COMPLETION DATE
<br />Dust Collector, Air Make up unit, new diameter tooling, Manufacturing Equipment 06/01/2011 06/01/2013
<br />progressive strap bracket die, leveler for shear, DC R & D Equipment
<br />transformer, retrofit resistance welders, laser cutter, roller, Logist Dist Equipment
<br />tester, automatic leak detection system for testers, forklift,
<br />cunt..... iT Equipment 06/01/2011 06/01/2013
<br />Current number Salaries Number retained Salaries Number additional Salaries
<br />72 3,000,000.00 72 1 3,000,000.00 115 600,000.00
<br />• • e s e •e•e --•
<br />NOTE. Pursuant to IG 6- 1.1- 12.1 -5.1 (d) (2) the MANUFACTURING R & Q EQUIPMENT LOGIST DIST
<br />EQUIPMENT EQUIPMENT IT EQUIPMENT
<br />COST of the property is oonfidential. COST ASSESSED COST ASSESSED COST ASSESSED COST ASSESSED
<br />VALUE VALUE VALUE VALUE
<br />Current values 3,010,218.00 903,065.00
<br />Plus estimated values of proposed project 1,130,DOD.00 339,000.00 45,000.00
<br />Less values of any property being replaced
<br />Net estimated values upon completion of project 4,940,218.00 1,242,065.00 45,000.00
<br />• a 1 e. 1• -• o
<br />Estimated solid waste converted (pounds) Estimated hazardous waste converted (pounds)
<br />Other benefits:
<br />e •
<br />f hereby certify that the representations in this statement are true,
<br />Sig natur ,f authorized r r sgntativa Title Date signed (month, day, year)
<br />C Controller 04/15/2011
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