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Red 6: <br />STATEMENT OF BENEFITS <br />PERSONAL PROPERTY f��y <br />Stale Form 51764 (R2112 -11) <br />Prescribed by the Department of Local Government Finan <br />CITY CLER:,:. <br />( <br />JT h s�i�D, IN <br />FORM SB -11PP <br />[TIACY NOTICE <br />h.,.�.E.1f,!..fnd any.p ncidlvHUal's <br />oalion u confidential; the <br />e flingg is public record <br />INSTRUCTIONS: or IC 6 -L7- 72.1 -5.1 c and (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 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 end /or research and development equipment, and/orlogistica/ distribution <br />equipment end /or Information technology equipment for which the person wishes to claim a deduction. Projects "planned or committed to after Ju)y 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 />end /or research and development equipment and /or logistical distribution equipment strayer Information techno logy 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 retom on a certified deduction schedule (Form <br />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 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 /ormsearch and <br />development equipment end /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 March 1 and the extended due sate o/ that year. <br />4. Properly owners whose Statement of Benefits was approved alter 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 /C 6- 1.1.12.1.4.5(d) and (a) apply to equipment installed after March 1, 2001, unless an alternative deduction schedule is <br />adopted by the designating body (IC 6.1.1- 12.1 -17). <br />SECTION •, <br />Name of taxpayer <br />MGE wholesale Inc <br />Address of lazzpp88yyer (onvum�ler8r� cify, state, and ZIP code) <br />5021 Nimtz Parxwey S N en I bsa62e' <br />Name of contact person <br />Bradley Foster <br />Telephone number <br />574 - 257-0020 <br />• • • s r <br />Name of designating body <br />Resolution number (s) <br />Location of property <br />County <br />DLGF (axing district number <br />Description of manufacturing equipment and /or research and development equipment <br />and /or logistical distribution equipment and /or information technology equipment. <br />ESTIMATED <br />ETION DATE <br />(use additional sheets if necessary) <br />Manufacturing Equipm <br />R 6 D Equipment <br />The naw company is a wholesale distribution start up /het will repuira raciang, foddifls, computers, furniture, fixtures <br />L <br />Logist Dist Equipment <br />15 <br />IT Equipment <br />5 <br />Current number Salaries Numberrelained Salaries Number additional <br />Sabres <br />�,I:t"ltoiorl • • • r • •••• s ••• <br />NOTE: Pursuant to IC 6.7.1.72.1.5.1 (d) (2) the MANUFACTURING R 8 D EQUIPMENT LOGIST DIST <br />E UIPMENT <br />R EQUIPMENT <br />COST of the property is confidential. E UIPME SE <br />COST ASSESSED COST COST ASSESSED <br />EED <br />VALUE <br />COST <br />ASSESSED <br />VALUE <br />Current values o 0 <br />Plus estimated values of proposed project <br />200000 <br />Less values of any properly being replaced <br />g <br />Net estimated values upon comptellon of project <br />200000 THD <br />• *1 <br />Estimated solid waste convened (pounds) NA <br />Estimated hazardous waste converted (pounds) NA <br />Other benefits: <br />SECTION 6 TAXPAYER CERTIFICATION <br />I hereby certify that the representations in this statement are true. <br />Signature or eulhonxed re tuts <br />Mlle <br />/y <br />%fK <br />Dele signed men day, year) <br />Fj lC <br />Z <br />Page 1 of 2 <br />