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;Yf^•_• STATEMENT OF BENEFITS <br /> ° . PERSONAL PROPERTY FORM SB-1 /PP <br /> ',x sofrt'i State Form 51764(R5/1-21) PRIVACY NOTICE <br /> • 4 s .y' Prescribed by the Department of Local Government Finance 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 6-1.1-12.1-5.1. <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 <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 of <br /> qualifying 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 persons 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 for <br /> 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 <br /> and development equipment and/or logistical distribution equipment and/or information technology equipment is installed and fully functional,unless a filing <br /> 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. <br /> 4. Property owners whose Statement of Benefits was approved,must submit Form CF-1/PP annually to show compliance with the Statement of Benefits. <br /> (IC 6-7.1-12.1-5.61 <br /> 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. <br /> 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) <br /> SECTION 1 TAXPAYER INFORMATION <br /> Name of taxpayer Name of contact person <br /> Hoosier Tank and Manufacturing LLC Fr N.itne Nancy last`ame Miller <br /> Address of taxpayer Vumhe:.u,,l Strvo City State '/.IP Telephone number F.m.ril <br /> 1710 N Sheridan St South Bend IN 46628 (269)683-2550 nmiller@modineer.com <br /> SECTION 2- LOCATION AND DESCRIPTION OF PROPOSED PROJECT <br /> Name of designating body Resolution number(s) <br /> Common Council of the City of South Bend <br /> Location of property ',un her.md Si reef City Sias. ZIP County DLGF taxing district number <br /> 1710 N Sheridan St South Bend IN 46628 St. Joseph 026(South Bend-Portage) <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 9/1/2024 12/31/2026 <br /> Company is planning $4M in new manufacturing equipment I , <br /> purchases along with highly automated powder coating R&D Equipment <br /> equipment. Logist Dist Equipment <br /> IT Equipment <br /> SECTION 3 ESTIMATE OF EMPLOYEES AND SALARIES AS RESULT OF PROPOSED PROJECT <br /> �.. �'-npet Salaries Number Retained Salaries Number Additional Salaries <br /> 112 $5,824,000 112 $5,824,000 5 $260,000 <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 ASSESSED COST ASSESSED COST ASSESSED <br /> VALUE VALUE VALUE VALUE <br /> Current values <br /> Plus estimated values of proposed project 54.000.000 S 1,200,000 _ I <br /> Less values of any property being replaced <br /> Net estimated values upon completion of project $4,000,000 $1,200,000 $0 $0 S 0 $0 S 0 $0 <br /> SECTION 5 WASTE CONVERTED AND OTHER BENEFITS PROMISED BY THE TAXPAYER <br /> Estimated solid waste converted(pounds) I Estimated hazardous waste converted(pounds) <br /> Other benefits' <br /> SECTION 6 TAXPAYER CERTIFICATION <br /> I hereb certify that the representations in this statement are true. <br /> Signal re o authohzed rrepres nl ive Date signed(month.da.year) <br /> Printed name of authorized representative Title <br /> Donna Harbin Corporate Controller <br /> Page 1 of 2 <br />