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<br /> STATEMENT OF BENEFITS 1 PP
<br /> PERSONAL PROPERTY FORM 5B-1
<br /> s State Form 51764(R2112-11) n
<br /> 'a ✓" Prescribed by the Department of Local Government Fine ce PRIVACY NOTICE
<br /> w - - The cost and any specific individual's
<br /> salary information is confidential;the
<br /> C: yr tr balance of the filing is public record
<br /> C-ITY CLEF14, j-,pOf,�3P.ND,Igo' per tC 6-1.1-12.1-5.t CJ and(d).
<br /> INSTRUCTIONS:
<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(Fora
<br /> 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
<br /> township. The 103-ERA must be filed between March i and May 15 of the assessment year in which new manufacturing equipment and/or research and
<br /> development equipment and/or logistical distribution equipment and/or information technology equipment is installed and fulty functional, unless a filing
<br /> extension has been obtained. A person who obtains a filing extension must 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 ofBenefrts. (IC 6-1.1-12.1-5.6)
<br /> 5. The schedules established under IC 6-1.1-12.1-4.5(d)and(e)apply to equipment installed after March 1, 2001,unless an alternative deduction schedule is
<br /> adopted by the designating body(iC 6-1.1-12.1-17).
<br /> • TAXPAYER I N FORMATION
<br /> Name of taxpayer
<br /> GENERAL SHEET METAL WORKS, INC.
<br /> Address of taxpayer(number and street,city,state,and ZIP code)
<br /> 1902 SOUTH MAIN STREET, SOUTH BEND, IN 46613
<br /> Name of contact person Telephone number
<br /> JEFFREY M MCGOWAN,CPA,TAXPAYER REPRESENTATIVE,POWER OF ATTORNEY (574)289-4011
<br /> Name of designating body Resolution number(s)
<br /> SOUTH BEND COMMON COUNCIL
<br /> Location of property County DLGF taxing district number
<br /> 1902 SOUTH MAIN STREET, SOUTH BEND, IN 46613 SAINT JOSEPH COUNTY 71
<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 it necessary) START DATE COMPLETION DATE
<br /> Trumpf 3030 CNC laser cutting machine Manufacturing Equipment 04/01/2013 03/31/2015
<br /> CNC Tube Bender R&D Equipment
<br /> Davi Roll
<br /> Trumpf Laser 7036 Logist Dist Equipment
<br /> IT Equipment
<br /> Current number Salaries Number retained Salaries Number additional Salaries
<br /> 112 4,850,000.00 112 4,850,000.00 9 388,673.00
<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 ASSESSED COST ASSESSED COST ASSESSED
<br /> VALUE VALUE VALUE VALUE
<br /> Current values 13,256,533.00 3,975,650.00
<br /> Plus estimated values of proposed project 1,730,000.00 519,000.00
<br /> Less values of any property being replaced 0.00 0.00
<br /> Net estimated values upon completion of project 14,986,533.00 4,494,650,00
<br /> Estimated solid waste converted(pounds) Estimated hazardous waste converted(pounds)
<br /> Other benefits:
<br /> I hereby certify that the representations In this statement are true.
<br /> ig atu of uthorize esen a Title pate signed(month,day,year)
<br /> TAX REPRESENTATIVE,POA 02(20/2013
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