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<br /> $ STATEMENT OF BENEFITS l`ORM SBA I PP
<br /> is PERSONAL PROPERTY
<br /> ** State Form 51764(R 11-06)
<br /> Prescribed by the Department of Local Government Finance PRIVACY NOTICE
<br /> The cost and any speoifsc individual's
<br /> salary information is confidential;
<br /> balance of the filing is public record
<br /> INSTRUCTIONS. per IC 6-1,1-12.1-5-1(c)and MI.
<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, 1967,
<br /> and areas designated after July 1, 1987,require a STATEMENT OF BENEFITS.
<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 deveoopment 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 extension 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 6-1.1-12.1-5.6)
<br /> 5. The schedules established under IC 6-1.1-12.1-4.5(d)and(,,)apply to equipment installed after March 1,2001. For equipment installed prior to March 2,
<br /> 200f, the schedules and statutes in effect at the time shaft•seradi ar re-f"pply .(!C_fz 1.1 12..1,4:5ff�.g9V(g))
<br /> Name of taxpayer i
<br /> 1Federal-Mogul Powertrain, Inc.
<br /> Address of taxpayer(number and street,city,state,and ZiP code) '.d 47
<br /> 3605 W. Cleveland Rd., South Bend, IN 46628 " i
<br /> 4
<br /> Name of contact person Telephone number
<br /> Charles O'Connor, Plant Controller
<br /> fart., (574)271-5910
<br /> Name of designating body
<br /> Resolution number(s)
<br /> City of South Bend Common Council
<br /> Location of property County DLGF taxing district number
<br /> 3605 W. Cleveland Rd., South Bend, IN 46628 St. Joseph 71008-German Twp.
<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 /> 1) Manufacturing Equipment-Gen V 5.31- Piston Line Manufacturing Equipment 2012 2014
<br /> 2) Manufacturing Equipment- Gen V 4.31-16.2L Piston Line
<br /> 3) Manufacturing Equipment- LKW 2.51- Piston Line R 8 D Equipment 2012 2013
<br /> 4) R&D Equipment- Prototype Lab Logist Dist Equipment
<br /> 5)Aluminum Bulk Melt Furnace- Ford Nano
<br /> IT Equipment
<br /> a s r r ® e •r•r � .•®
<br /> Current number Salaries Number retained Salaries Number additional Salaries
<br /> 4Q9 20,053,000 1409 20,053,000 120 932,000 .
<br /> e •.-r o • •e
<br /> NOTE:Pursuant to IC 6-1.1-12.1-5.1 (d)(2)the MANUFACTURING R&D EQUIPMENT LOGIST DIST
<br /> EQUIPMENT EQUIPMENT IT EQUIPMENT
<br /> COST of the property is confidential. COST ASSESSED COST ASSESSED COST ASSESSED COST ASSESSED
<br /> VALUE VALUE VALUE VALUE
<br /> Current values 84,270,4D5 24,014,0134 Casi&.UdYalu IndudedinM&E
<br /> Plus estimated values of proposed project 18,340,000 5,502,000 3,462,000 1,036,600
<br /> Less values of any property being replaced o D 0 .0
<br /> Net estimated values upon completion of project 1D2,S10,4D5 29,51b,04 3,462,000 1,036,600
<br /> e e a re •w re
<br /> Estimated solid waste converted(pounds) Estimated hazardous waste converted{pounds}N/A _
<br /> Other benefits:
<br /> 71esI hereby certify that th e representations in this statement are true.
<br /> orized representative cl' Title Date signed(month,day,year)Connor, Federal-Mogul awertrain, Inc. Piant Controller ,1�
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