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STATEMENT OF BENEFITS FORM SB -1 / PP <br />PERSONAL PROPERTY <br />State Form 51764 (R / 1-06) <br />Prescribed by the Department of Local Government Finance PRIVACY NecO�TcICE <br />salary tinforawg nb IndiNdual'e <br />t>aMxlentlac the <br />- tudena of the b btic roeoM <br />INSTRUCTIONS rIG 6.1.1.13.15.1 c vW d. <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 desisbn about whetherto designate an Economic RevifalizatanArea. Otherwise kris ataremem must be submitted <br />to the designakrg bodyBEFOREe person hstafls the new manufacturing 4rquvinemarnd/arreseamh and devebpment equipment, and/orbgiskal disMbution <br />equipment and/orintormation technology equipment for which the person wishes fo dalm a deduction. ?ro)ects' planned orcommided to akerJuty 1, 1957, <br />and areas designated ekerJUly 1, 1967, requJna a STATEMENT OFBENEFITS. (1C 6 -1.1 -12.1) <br />2. Appro val of the designating body (City 6oundll, Town Board, County Councli, eta.) must be obtained prior to Installation of the new manufacturing equipment <br />and/or research and development equipment and/or logisdcal distribution equipment and/orintimation technology equipment, BEFORE a deduction may <br />be approved <br />3. To obtain a deduction, a person must file a cerlMed deduction schedule with the person's personal property return on a certified deduction schedule (Form <br />103 -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 <br />assessment year in which new manufacturing equipment end /or research and development equipment and/or logistical distribution equipment and/or <br />information technology equipment Is installed and fully functional, unless a riling extension has been obtained. A person who obtains a riling extension must <br />fife 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, <br />Statement of Benefits. #C6-1.1-1Z1-5.6) <br />5. The schedules established under IC 64.1 - 12.1- 4.5(d) and (e) apply to equlpn <br />2001, the schedules and statutes in effect at the time shall continua to am 1v r <br />1991, must submit Form CF -1 / PP annually to show compliance with the <br />it installed after March 1, 2001. For equipment Installed pdor to March $ <br />6-1.1- 1214.5(8 and (a)) <br />South Bend Gear, LLC <br />Address of taxpayer (numberand street, ally; state, and ZIPoodal <br />3849 Showerlux <br />JAN 2 8 2411 <br />Drive, South Bend, Indiana 46628 <br />Name of contact person 'telephone number <br />Stan JOHN VOOROE ' (574)234 -411s <br />2 <br />SECTION . e <br />Name of designating body Resolutlon nu (s) <br />South Bend Common Council ( nmbper .r <br />Location of property <br />County DLGF taxing district number <br />3849 Showerlux Drive, South Bend, Indiana 46628 <br />St. Joseph 71.009 <br />Description of manufacturing equipment and/or research and development equipment <br />and /or logistical distribution equipment and /or information technology equipment. ESTIMATED <br />(use additional sheets IF necessary) START DATE COMPLETION DATE <br />See attached 2 Sheets. Manufacturing Equipment 07/01/2011 06/30/2013 <br />R & D Equipment <br />Logist Dist Equipment <br />IT Equipment <br />• <br />Cunent number Salaries Number retained Salaries Number addAWW <br />Salaries <br />0 0.00 0 0.00 12 <br />550,000.00 <br />TURING R b D EQUIPMENT LOGIST DIST <br />NOTE: Pursuant to IC 6 -1.1- 12.1 -5.1 (d) (2) the ENT <br />IT EQUIPMENT <br />property rty is confidential. EQUIPMENT <br />COST of the roe ASYS�E SED ASSESSED COSTED <br />COST <br />L'IQ <br />Cunent values .00 <br />Plus estimated values of proposed project ,240,000.00 <br />Less values of any property being replaced .00 <br />Net estimated values upon completion of project 24g000.0, <br />• • • <br />• .: <br />Estimated solid waste converted (pounds) <br />Estimated hazardous waste converted (pounds) <br />Other benefits; <br />Total employees to be hired is estimated to be 26 by the completion date. <br />SECTION 6 <br />TAXPAYER CERTIFICATION <br />I hereby certify that the representations M this statement are We. <br />r Ssignature of authorized representative <br />Title <br />Date signed (month, day, yead <br />WiL— <br />Manager <br />1 01/28/2011 <br />