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Filed In Clark's offlce <br />STATEMENT OF BENEFITS <br />PERSONAL PROPERTY 4 2M FORM SB•1 / PP <br />Slate Form 51764 (R2/12-11) <br />S J' Prescribed by the Department of Local Government Finan e _ <br />JOHN •F-- {r��}s - PRIVACY NOTICE <br />VCi The cost antl any Speer. individual's <br />CI7Yp1Ep1(,11p{)yyjij�yprlpy salaryinlo_ationisconfidential; the <br />balance of the filing is public record <br />INSTRUCTIONS: per IC 6 -1.1- 12.1 -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 mustba 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 commlited to after July 1, 1987, <br />and areas designated after July 1, 1987, require a STATEMENT OF BENEFITS. <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/orlogistical distribution equipment and/orinfcrmation technology equipment, BEFORE a deduction may <br />be approved <br />3. To obtain a deduct(on, a person must file a certified deduction schedule with the person's personal property return on a centfied deduction schedule (Form <br />103 -ERA) with the township assessor of the township where the property is situated or with the county assessorif 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 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 file 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, 1ggi, must submit Form CF1 /PP annually to show compliance with the <br />StatementofBenefits. (lC 6d: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, unless an alternative deduction schedule is <br />adopted by the designating body (IC 6- 1.1- 12.1 -17). <br />Name of o <br />Daniel Kruk <br />Kruk Electric <br />of <br />Suite 4044 South Bend, IN 46619 <br />and /or <br />Wire forming and spring manufacturing equipment. <br />Current number <br />4 <br />Number <br />4 <br />Manufacturing Equipn <br />R & D Equipment <br />Logisl Dist Equipment <br />IT Equipment <br />nesomtion number (s) <br />DLGF taxing district number <br />ESTIMATED <br />START DATE COMPLETION DATE <br />5/1/2015 16IM015 <br />NOTE: Pursuant to IC 6.1.1- 12.1 -5.1 (d) (2) the <br />MANUFACTURING <br />R & D EQUIPMENT <br />LOGIST DIST <br />COST of the property is confidential, <br />E UIPMENT <br />EQUIPMENT IT EQUIPMENT <br />COST ASSESSED <br />VALUE <br />ASSESSED <br />COST VALUE <br />COST ASSESSED COST ASSESSED <br />Current values <br />$175,((( Sns,(o( <br />VALUE VALUE <br />Plus estimated values of proposed project <br />$175,000 51'15,000 <br />Less values of any properly being replaced <br />Net estimated values upon completion of project <br />$175,000 $175,00( <br />Estimated solid waste converted (pounds) N/A <br />Estimated hazardous waste <br />converted (pounds) NfA <br />