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Filed in Cler ' 4 101 <br /> L______ _ ,STATEMENT OF BENEFITS - FORM SB-1 /PP <br /> 1.64 PERSONAL PROPERTY NOV 0 Z01z <br /> %, State Form 51764(R/1-06) <br /> '' Prescribed by the Department of Local Government Finance _ y PRIVACY NOTICE <br /> _.. N i The cost and any specific individual's <br /> ,it+C�h,'a Eft C9e salary information is confidential;the <br /> CITY CLERK,Wild fl BEND,III balance of the filing is public record <br /> INSTRUCTIONS: <br /> per IC 6-1.1-12.1-5.1(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 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 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 lC 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 6-1.1-12.1-4.5(1)and(g)) <br /> SECTION 1 TAXPAYER INFORMATION <br /> Name of taxpayer <br /> TK.1,4 N6L C /'I.4C-M/NE J.1A/c. <br /> Address of taxpayer(number and street,city,state,and ZIP code) <br /> 3"70 ,2 W . 5/-M PL t s T. S OrTE i la g- 560 Ill PEAJi ,Im 1/66 ! q <br /> Name of contact person 114 A �� Telephone number <br /> Ti. -a#6 -- DI6r <br /> SECTION 2 LOCATION AND DESCRIPTION OF PROPOSED PROJECT <br /> Name of designating body Resolution number(s) <br /> iCiA1vG�L i Aift e-I-1!Nc T-Nc . . <br /> Location of property _ County DLGF taxing district number <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 /> 0 )K U M P r - a Ax 15 C N C TL,R N I N C r Manufacturing Equipment 1 p .. is- _ ,? i^t „n - l� <br /> tI\1 E,R R&D Equipment d d, I <br /> Logist Dist Equipment <br /> IT Equipment <br /> SECTION 3 ESTIMATE OF EMPLOYEES AND SALARIES AS RESULT OF PROPOSED PROJECT <br /> Current number 2 Salaries r O O O 0 Number retained Salaries DD T Number additional • Salaries <br /> LJ 0 0 <br /> SECTION 4 ESTIMATED TOTAL COST AND VALUE OF PROPOSED PROJECT <br /> MANUFACTURING R&D EQUIPMENT LOGIST DIST IT EQUIPMENT <br /> NOTE:Pursuant to IC 6-1.1-12.1-5.1 (d)(2)the <br /> EQUIPMENT EQUIPMENT <br /> COST of the property is confidential. COST ASSESSED COST ASSESSED COST ASSESSED COST ASSESSED <br /> VALUE VALUE VALUE <br /> Current values g7,a.Io 120 VALUE <br /> Plus estimated values of proposed project <br /> Less values of any property being replaced <br /> Net estimated values upon completion of project ; ._ s/ i DV <br /> SECTION 5 WASTE CONVERTED AND OTHER BENEFITS PROMISED BY THE TAXPAYER <br /> Estimated solid waste converted(pounds) N v A Estimated hazardous waste converted(pounds) IN 4 <br /> Other benefits: <br /> SECTION 6 TAXPAYER CERTIFICATION <br /> I hereby certify that the representations in this statement are true. <br /> Signature of authorized representative — Title <br /> Date signed(month,day,year) <br /> AILO I nr.: ./ 3e.c re_.;171 I ! , 11 <br />