Bill No. 23-01 Tax Abatement properties 2652 Jaclyn Ct, SB, IN 3161 Young Ct, SB, IN

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„ '►q, STATEMENT OF BENEFITS FORM SB-1 /PP PERSONAL PROPERTY State Form 51764(R4/11-15) Prescribed by the Department of Local Government Finance PRIVACY NOTICE Any information concerning the cost of the property end specific salaries paid to individual employees by the property owner is confidential per IC 6-1.1-12.1-5.1. INSTRUCTIONS y, This statement must be submitted to the body designating the Economic Revitalization Area prior to the public hearing if the designating body requires information from the applicant in making its decision about whether to designate an Economic Revitalization Area. Otherwise this statement must be submitted to the designating body BEFORE a person installs the new manufacturing equipment and/or research and development equipment, and/or logistical distribution equipment and/or information technology equipment for which the person wishes to claim a deduction. 2. The statement of benefits form must be submitted to the designating body and the area designated an economic revitalization area before the installation of qualifying abatable equipment for which the person desires to claim a deduction. 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 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 for the township. The 103-ERA must be filed between January 1 and May 15 of the assessment year in which new manufacturing equipment and/or research and development equipment and/or logistical distribution equipment and/or information technology equipment is installed and fully 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 due date of that year. 4. Property owners whose Statement of Benefits was approved,must submit Form CF-1/PP annually to show compliance with the Statement of Benefits. (IC 6-1.1-12.1-5.6) 5. For a 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. For a 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) SECTION 1 TAXPAYER INFORMATION it Name of taxpayer Name of contact person The Robert Henry Corporation Brian Henry Address of taxpayer(number and street,city,state,and ZIP code) Telephone number 404 South Frances Street, South Bend, 46624 (574 ) 232-2091 SECTION 2 LOCATION AND DESCRIPTION OF PROPOSED PROJECT Name of designating body Resolution number(s) Location of property County DLGF taxing district number 3161 Youngs Ct St Joseph Description of manufacturing equipment and/or research and development equipment ESTIMATED and/or logistical distribution equipment and/or information technology equipment. START DATE COMPLETION DATE (Use additional sheets if necessary.) Manufacturing Equipment R&D Equipment Logist Dist Equipment IT Equipment SECTION 3 ESTIMATE OF EMPLOYEES AND SALARIES AS RESULT OF PROPOSED PROJECT Current number Salaries Number retained Salaries Number additional Salaries SECTION 4 ESTIMATED TOTAL COST AND VALUE OF PROPOSED PROJECT NOTE:Pursuant to IC 6-1.1 12.1-5.1 (d)(2)the MANUFACTURING R&D EQUIPMENT LOGIST DIST IT EQUIPMENT EQUIPMENT EQUIPMENT COST of the property is confidential. COST ASSESSED COST ASSESSED COST ASSESSED COST ASSESSED VALUE VALUE VALUE VALUE Current values Plus estimated values of proposed project Less values of any property being replaced Net estimated values upon completion of project SECTION 5 WASTE CONVERTED AND OTHER BENEFITS PROMISED BY THE TAXPAYER Estimated solid waste converted(pounds) Estimated hazardous waste converted(pounds) Other benefits: SECTION 6 TAXPAYER CERTIFICATION I hereby certify that the representations in this statement are true. Signature of authorized representative Date signed(month,day,year) February 1, 2023 Printed name of authorized representative Title Brian Henry President Page 1 of 2