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R STATEMENT OF BENEFITS <br /> ;:iii;..,,`,.,... PERSONAL PROPERTY FORM SB-1/PP <br /> '' State Form 51784(R4/11-15) <br /> Prescribed by the Department of Local Government Finance PRIVACY NOTICE <br /> Any Information concerning the cost <br /> of the property and specific salaries paid <br /> to individual employees by the property <br /> owner is confidential per IC 8-1 1-12.1-5 1 <br /> INSTRUCTIONS <br /> 1. This statement must be submitted to the body designating the Economic Revilalizatfon 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 <br /> submitted to the designating body BEFORE a person installs the new manufacturing equipment and/or research and development equipment,and/or <br /> logistical distribution equipment and/or information technology equipment for which the person wishes to claim a deduction. <br /> 2. The statement of benefits form must be submitted to the designating body and the area designated an economic revitalization area before the installation <br /> of qualltying abatable equipment for which the person desires to claim a deduction. <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 <br /> (Form 103-ERA)with the township assessor of the township where the property is situated or with the county assessor If there is no township assessor <br /> for the township. The 103-ERA must be flied between January 1 and May 15 of the assessment year In which new manufacturing equipment <br /> and/or research and development equipment and/or logistical distribution equipment and/or information technology equipment is installed and fully <br /> functional,unless a filing extension has been obtained. A person who obtains a filing extension must file the form between January 1 and the extended <br /> due date of that year. <br /> 4. Properly owners whose Statement of Benefits was approved,must submit Form CF-1/PP annually to show compliance with the Statement of Benefits. <br /> (1C 6-1.1-12.1-5.6) <br /> 5. Fora Form SB-1/PP that is approved after June 30,2013,the designating body is required to establish an abatement schedule for each deduction allowed. <br /> Fora Form SB-1/PP that Is approved prior to July 1,2013,the abatement schedule approved by the designating body remains in effect. (iC 6-1.1-12.1-17) <br /> SECTION 1 TAXPAYER INFORMATION <br /> Name of taxpayer Name of contact person <br /> WSJM-INC Dave Doetsch <br /> Address of taxpayer(number and street.city slate,and ZIP code) Telephone number <br /> 1301 East Douglas Road, Mishawaka, IN 46545 269-925-1111 <br /> SECTION 2 LOCATION AND DESCRIPTION OF PROPOSED PROJECT <br /> Name of designating body fiesriutton number(s) <br /> City of South Bend <br /> Location of property County DLGF taxing district number <br /> 316 East Monroe Street St.Joseph County <br /> Description of manufacturing equipment and/or research and development equipment ESTIMATED <br /> and/or logistical distribution equipment and/or information technology equipment. START DATE COMPLETION DATE <br /> (Use additional sheets if necessary.) <br /> Manufacturing Equipment ' <br /> • <br /> R&D Equipment <br /> Logist Dist Equipment i <br /> IT Equipment 12/7/20 2/12/21 <br /> SECTION 3 ESTIMATE OF EMPLOYEES AND SALARIES AS RESULT OF PROPOSED PROJECT <br /> Current number Sotar:os 'Number retained Salaries Number additional Salaries <br /> 23 $1,040,520 03 4.1,040,520 i <br /> $104,957 <br /> SECTION 4 ESTIMATED TOTAL COST AND VALUE OF PROPOSED PROJECT <br /> NOTE:Pursuant to IC 6-1.1-12.1-5.1(d)(2)the MANUFACTURING R&D EQUIPMENT LOGIST DIST IT EQUIPMENT • <br /> EQUIPMENT EQUIPMENT <br /> COST of the property is confidential. COST ASSESSED COST l ASSESSED COST ASSESSED COST ASSF ED <br /> VALUE VALUE VALUE VALUE i <br /> Current values I I <br /> Plus estimated values of proposed project $50,000 5800,000 • <br /> Less values of any property being replaced 0 <br /> Net estimated values upon completion of project <br /> SECTION 5 WASTE CONVERTED AND OTHER BENEFITS PROMISED BY THE TAXPAYER <br /> Estimated solid waste converted(pounds) Estimated hazardous waste converted(pounds) ' <br /> Other benefits: . <br /> SECTION 6 TAXPAYER CERTIFICATION <br /> I hereby certify that the representations in ' statement are true. <br /> Si nature of authoriz re tative Dele signed(month,day,year/ <br /> f April 8, 2020 <br /> Print of authorized rep ntative Title <br /> Dave Doetsch (President <br /> Page 1 of 2 <br />