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Fig Office <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 <br /> Page 1 of 2 <br />