Laserfiche WebLink
STATEMENT OF BENEFITS <br />PERSONAL PROPERTY <br />State Form 51764 (112112 -11) <br />Prescribed by the Department of Local Government Finance <br />CI <br />I FORM SBA IPIP I <br />PRIVACY NOTICE <br />The tail ant arty np•dfw indirkluarn <br />salary information is cgnrgential; the <br />• ^M avY..194 ?g�jy. balance of Ole flingg is puNlcrecord <br />INSTRUCTIONS: L p er IC 6- i.i•72. i•5.1 c)and [d) ' <br />1. This stafement 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/orlogistice/ disfributi <br />equipment and/or information techno logy equipment for which the person Wishes to calm a deduction. Projects' planned or e"I' an committed to after ✓o/y 1, 198 on <br />and areas designated after July 1, 1987, require a STATEMENT OF BENEFITS. (tC e- 1,1.121) <br />2. Approval of the designating body (City Council, Town Board, County Council, etc.) must be obh lnedpHo to installation of the new manufacturing equipment <br />and /or research and development equipment and/orlogistica/ distribution equipment and/orinformalion technology equipment BEFORE a deduction may <br />be eppmvod <br />3. To obtain a deduction, a person must file a certified deduction schedule Willi the person's personal property return on a certified deduction schedule (Form <br />103 -ERA) with fire township assessor of the township where the properly 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 1 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 fully functional, unless a filing <br />extension has been obtained. A person who obtains a filing extension must fife the form between March 1 and the extended due date of that year, <br />4. Properly owners whose Statement of Benefits was approved after Juno 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 6.1.1- 12.1- 4.5(d) and (e) apply to equipment installed after March 1, 2001, un less an alternative deduction schedule is <br />adopted by the designating body (IC 6-1.1. 12.1.17). <br />Address of n�xpayest�n�r�rbera�>ie2 t city stale, and 2lPcode) <br />2820 "edam 6 <br />w. end. d <br />Name of conLacl person <br />nnm Hertz <br />Telephone number <br />574433-9424 <br />Name or designaling body <br />Mark Todd Cs,,ro nnp <br />Resolution number (s) <br />LOedtlan of P�opmtyy <br />Count <br />2820 VMtllan Drrva. Sov" Bend. IN 46628 <br />DLGF taxing district number <br />St Joseph <br />Description or manufacturing equipment and /or research and development equipment <br />and/or logistical distribution equipment and /or information technology equipment. ESTIMATED <br />(use additional sheets i(necessary) <br />START DATE COMPLETION DATE <br />Manufacturing Equipment <br />R It D Equipment <br />cNC Mills. . CNC Laes, Hones, Laps, Inspedim Equipment <br />Logist Disl Equipment <br />IT Equipment <br />• • jell <br />Current number Snlades Number retained <br />• ..•.• • „• <br />Salaries <br />3 M 60 <br />3Indlon JSmbered0onal Salaries <br />1.75 rrtilNan <br />• I • • a <br />• -••• • ••• <br />NOTE: Pursuant to IC 6.1.1- 12.1 -5.1 d 2 the MANUFACTURING <br />( ) () EQUIPMENT <br />R 8 D EQUIPMENT LOGI$T DIST <br />COST of the properly is confidential. <br />EQUIPMENT IT EQUIPMENT <br />COST ASSESSED <br />VALUE <br />COST ASSESSED COST ASSESSED COST A SESSED <br />VALUE <br />Current values 7aibm 2mnim <br />VALUE SA <br />- <br />Plus estimated values of proposed project 5 md6m 5 tsdim <br />Less values of any properly being replaced <br />o 0 <br />NeI estimated values upon completion of project 12 mit= 6.0mibm <br />Estimated solid waste converted (pounds) <br />Estimated hazardous waste converted (pounds) <br />Other beneels: <br />1 hereby certify that the representations in this statement are Ime. <br />Signature o(aulharized representative <br />Tine <br />P asked <br />Dale signed (month, day, year) <br />0.6/2014 <br />Page 1 of 2 <br />