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STATEMENT OF BENEFITS <br />PERSONAL PROPERTY <br />✓, State Fees 61784 (R 1 1.06) <br />Prescribed by the Department of Local Government Finance <br />FORM SB•1 I PP <br />PRIVACY NOTICE <br />The mat and any sgMfic IndlNduW'e <br />salary Information Is owdidmdial: 0,8 <br />balance d the 02gIs public mcord <br />ICr11.I -02.1fi.1 c 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 m training Its decision about whether to deslgnals an Economic RevtlelizetronArea. Otherwise this statement must be submitted <br />to the designating body BEFORE a person Installs the new manufacbring equipment and/or research and development equlpmenl, and/or logistical distribution <br />equipment and/or Information technology equipment for which the person wishes to claim a deduction. 'Pm)octs° planned or commftted to e6erJuly 1, 1987, <br />and areas designated after July 1, 1987, require a STATEMENTOF 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 />und/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 <br />103 -ERA) with the township assessor of the township where the property is situated. Tire 103 -ERA must be filed between March 1 and May 15 of the <br />assessment year in which new manufacturing equipment and/or research and development equipment and/or logistical distribution equipment and/or <br />iniomrellon technology equipment s Installed and fully functional, unless a filing exlens /on has been obtained. A person who obtains a ftling extension must <br />file Me corm between March 1 and the extended due date of that year. <br />4. Property owners whose Slatannent of Benefits was approved after June 30, 1991, must submit Form CF -1 / PP annually to show compliance with the <br />Statement of Benefits. (IC 6 -1.1- 12.1 -5.6) <br />5. The schedules established under IC 6 -1. fa2.1- 4.5(dJ and (a) apply to equipment Installed after March 1, 2001. For equipment Installed prior to March 2, <br />2001, the schedules and statutes in effect of the time shell continue to apply. (IC 6 -f.1. 12.14.5(1) and (g)) <br />SECTION 1 TAXPAYER INFORMATION <br />Name of taxpayer <br />Lippert Components Manufacturing, Inc. <br />Address of taxpayer Pwmborard aberd, city state, end' Z/Pcadot <br />3501 County County Road 6 East, Elkhart, IN 46514 <br />Name M contact person <br />R4epllone number- <br />Scott McPhail, VP Finance <br />(S74)312-6M <br />SECTIO ON D DrSCRIPTION OF •a•• PROJECT <br />Nam. ddoalgnadng body <br />Ros Vw number (a) <br />South Bend Common Council <br />Location of property <br />Cam <br />DLGF teeing district number <br />1902 West Sample Street, South Bend, Indiana 46619 <br />St. Joseph <br />Description of manufacturing equipment and /or research and development equipment <br />ESTIMATED <br />and/or Icglslical distribution equipment arrdlm Information technology equipment, <br />START DATE <br />COMPLETION DATE <br />(use addfllonal steels if necessaty) <br />Manufacturing Equipment <br />Racking, forklifts and computers. <br />R 8 D Equipment <br />Logist Dist Equipment <br />04/01/2014 <br />12/31/2018 <br />IT Equipment <br />04101/2014 <br />12131/2018 <br />SECTION OF • AND SALARIES AS RESULT OF •••• • PROJECT <br />Cunent number edemas Number retained Selmiea Number addltiorrel Salaries <br />0. _ ...._..._..._._0.00_.___.. 0 0.00 260 12.50 <br />SECTION 4 ESTIMATED TOTAL COSTAND VALUE OF PROPOSED PROJECT <br />NOTE: Pursuant to IC 6.1.1- 12.1 -5.1 (d) (2) the MANUFACTURING R 8 D EQUIPMENT LOGIS7 DIST R EQUIPMENT <br />E IPMENT E UIPMENT <br />COST of the property is confidential. COST At E6 COST D COST N` EED COST � SS ED <br />0 <br />values <br />am <br />0.00 <br />0.00 <br />o.00 <br />o.m am om <br />cm <br />Plus estlmated values of proposed p v)ed <br />zaao,aoom 7awm0.ao anmaao <br />so,000.ao <br />Less values of any Property being replaced <br />_ <br />Net estimated values upon completion of project <br />a.ao <br />om <br />to <br />o.00 <br />zxw.a0o.00 zaso.aoom soo0o.ao <br />s0aoo.00 <br />SECTION 5 WASTE CONVERTED AND OTHER BENEFITS <br />PROMISED DYTHE TAXPAYER <br />Estimated solid waste convened (pounds) <br />Estimated hazardous waste convened (pounds) N <br />otherbene6ls: <br />The company$ potential use of this facility will reeull In the company occupying a bulling which has been vacant for more than 8 months. In addition to the direct <br />company investment at this facility, the company wia sub -lease some of the space at ure facility and the tenant will also create jobs and make copilot investments. <br />SECTION 0 TAXPAYER CERTIFICATION <br />I hereby certify that the representabons In this statement are We. <br />Signal a out e r nlativ ^ <br />Title- <br />oatie a t nth, boy, year) <br />i <br />