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�• RAT• <br />a' STATEMENT OF BENEFITS <br />xi <br />l= PERSONAL PROPERTY <br />State Form 51764 (R / 1 -06) <br />•� Prescribed by the Department of Local Government Finance <br />F <br />FORM S13-1 If PP <br />PRIVACY NOTICE <br />The cost and any specific individual's <br />salary information is confidential; the <br />balance of the filing is public record <br />per IC 6 -1.1- 12.1 -5.1 (c) and (d). <br />INSTRUCT IONS: <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 103 - <br />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 assessment <br />year in which new manufacturing equipment and /or research and development equipment and /or logistical distribution equipment and /or information technology <br />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 <br />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 Statement <br />of Benefits. (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. 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 (I) and (g)) <br />SECTION •• • <br />Name of taxpayer <br />UNIVERSITY OF NOTRE DAME DU LAC, INNOVATION PARK AT NOTRE DAME, INC., AND FUTURE TENANTS <br />Address of taxpayer (number and street, city, state and ZIP code) <br />C/O PHILIP J. FACCENDA, BARNES & THORNBURG LLP, 100 N. MICHIGAN ST., STE. 600, SOUTH BEND, IN 46601 <br />Name of contact person <br />Telephone number <br />PHILIP J. FACCENDA <br />(574) 233 -1171 <br />SECTION 2 LOCATION AND DESCRIPTION OF PROPOSED PROJECT <br />Name of designating body <br />Resolution number(s) <br />COMMON COUNCIL OF THE CITY OF SOUTH BEND <br />Location of property <br />County <br />DLGF taxing district number <br />EDISON RD., ADJOINING TWYCKENHAM DRIVE EXTENSION ON SR 23 <br />ST. JOSEPH <br />71026 <br />Description of manufacturing equipment and /or research and development equipment <br />ESTIMATED <br />and /or logistical distribution equipment and /or information technology equipment <br />Start Date <br />Completion Date <br />(use additional sheets if necessary) <br />Manufacturing Equipment <br />N/A <br />N/A <br />SEE EXHIBIT A FOR DESCRIPTION OF RESEARCH AND DEVELOPMENT <br />EQUIPMENT AND INFORMATION TECHNOLOGY EQUIPMENT CONTEMPLATED <br />R & D Equipment <br />SEE EX. A <br />SEE EX. A <br />BY PHASES I -IV OF INNOVATION PARK AT NOTRE DAME <br />Logist Dist Equipment <br />WA <br />N/A <br />IT Equipment <br />SEE EX. A <br />SEE EX. A <br />SECTION 3 ESTIMATE <br />OF EMPLOYEES AND SALARIES AS RESULT OF PROPOSED PROJECT <br />Current number Salaries <br />Number retained Salaries Number additional <br />Salaries <br />ZERO (0) ZERO (0) <br />NOT APPLICABLE NOT APPLICABLE SEE EXHIBIT A <br />I <br />SEE EXHIBIT A <br />SECTION 4 <br />ESTIMATED TOTAL COST AND VALUE OF PROPOSED PROJECT <br />NOTE: Pursuant to IC 6- 1.1- 12.1- 5.1(d)(2) the <br />COST of the property is confidential. <br />MANUFACTURING R & D EQUIPMENT LOGIST DIST <br />EQUIPMENT EQUIPMENT <br />IT EQUIPMENT <br />Cost <br />Assessed <br />Value <br />Cost <br />Assessed <br />Value <br />C ost <br />Assessed <br />Value <br />Cost <br />Assessed <br />Value <br />Current values <br />N/A <br />N/A <br />ZERO (0) <br />ZERO (0) <br />WA <br />N/A <br />ZERO (0) <br />ZERO (0) <br />Plus estimated values of proposed project <br />N/A <br />/A <br />SEE EX. A <br />SEE EX. A <br />INIA <br />NIA <br />SEE EX. A <br />SEE EX. A <br />Less values of any property being replaced <br />N/A <br />N/A <br />N/A <br />N /A,. <br />N/A <br />NIA <br />N/A <br />N/A <br />Net estimated values upon completion of project <br />N/A <br />N/A <br />EE EX. A <br />EE EX. A <br />N/A <br />NIA <br />SEE EX. A <br />SEE EX. A <br />SECTION • <br />OTHER BENEFITS PROMISED <br />Estimated solid waste converted (pounds) NOT APPLICABLE <br />Estimated hazardous waste converted (pounds) NOT <br />APPLICABLE <br />Other Benefits: <br />SECTION CERTIFICATION <br />--rrer-e—by <br />certify that the representations in this statement are true. <br />Signature ut orized representative <br />Title Date <br />signed (month, day, year) <br />John A. Sejdinaj <br />Vice President for Finance August <br />8, 2008 <br />