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STATEMENT OF BENEFITS <br />PERSONAL PROPERTY <br />Slate Form 51764 (R2 /12-11) <br />.� Prescribed by the Department of Local Government Finance <br />FORM S8.1 /PP <br />PRIVACY NOTICE <br />The coal and any ape one IMividual's <br />ealeryinfomtelion fs wnfgen5ai; the <br />tielenee of the OIN is public retard <br />INSTRUCTIONS: r1C6 -1.1- 12.1 -4�.1 tend 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 />inlarmalion /nom the eppliwnf in mating Rs degas /on about whafherto designate an Economic RevifelizefionArea. 9lherwise 'his statement mustba submitted <br />to the das/gnefingbodyBEFOREe person installs the new manulactudng equ /pmant antl/ormsearch and development equipment and/or bgistical disldbufion <br />equipment and/or Information technology equipment for which the person wishes to claim a deduction. Pro /ecfs "planned or committed fo aRenluly 1, 1987, <br />and arses pool nefed aRer July 1, 1987,. requae a STATEMENT OF BENEFITS. (lC Bd. f -12:7) <br />2. Approvalol (he designatng body (City C'on' Town Board, County Council, etc.) must be obtained pdorto instal /agon o /the newmanutaGUdng equ ipment <br />and/orreseamh and deveopment equ/pmnn! and /orbgla8cal dlsMbufion equipment and/arin/ormafion le�hnologya quipment BEFORE a deduction may <br />1, epprovad <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 -ER4) 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 tiled between March 1 end May 15 Of the assessment year In which newmanufactudng equipment and/ormssamh and <br />development equipment and/or logistical distribution equipment and /or Information techno logy equipment Is installed and fully functional, unless a filing <br />extension has been obtained. A person who obtains a riling extension must NO the form between March 1 and the extended due date of that year. <br />a. property owners whose Statement of Benefits was approved after June 30, 1991, must submit Form CF -1 / PP annually to show compliance with the <br />Statement of Benefits. <br />5. Theitedby the established under 8 -1.1- 12.1- 4.5(d)and(e) p o -e/ q ippienFi tied RFrM �nless an alternative deduction schedule is <br />aaoptedbylhedesionafinpbodvllC6 -1.7. 12.1 -171. R a in ���r� � 1Ift <br />Page 1 of 2 <br />Name of taxpayer <br />Manulaclurbp Technology, Im I - <br />0zrlvaa�Y�aar'�Iipmnl5ttee�eSOUN �e��11�1�6i6re, entl ZIPCpO'e) <br />_._- •�.._. <br />Name of contact person ____._ .._.�- <br />Mbheel Leaman, florins. Unit Manager Telephone number <br />CITY CLERK, SOUTH BEtm' Im 574- 233-9190 <br />• . . a .,., , --, <br />Name Of deslgnolln/g� dy <br />'4TH $_t COAIMO.V Ce4euc Resolution number (s) <br />Locatlonplpropeny4� Count <br />402 Nodh Shedtlan S9eet South SeM, IN 48819 <br />St J.eph OLGF taxing disldd number <br />Description or manufacludng equipment and /or research and development equipment <br />and /or logistical distribution equipment and /or information technology ESTIMATED <br />equipment. <br />(use additional sheets if necessary) <br />START DATE COMPLETION DATE <br />Manufacturing Equipment August 1. 2015 Decemb•r31,2017 <br />u r R & D Equipment September 1, 2015 December 31, 2017 <br />01 ievacanl Wilding to expaM manuracWdng ofwmponenla entl reeseazM aid tlevebpmentINwekinp procaeE <br />Logisl Dist Equipment August 1. 2015 D4oembe131.20J7 <br />IT Equipment July 1, 2015 Oacene»r31,2017 <br />• • • • • .. •.• • -•, <br />CUnenl number 25 Salaries NumberrekNed 6alarles Numberaddiliona7_ <br />995,000 <br />25 995000 Salaries <br />77 309W0 <br />• 10110 Mal 11-111MR111901 • a • -••• • ••• <br />NOTE: Pursuant to IC 6 -1.1- 12.1.5.1 (d) (2) the MANUFACTURING R 8 D EQUIPMENT LOGIST DIST <br />EQUIPMENT <br />COST of the property (s Confidential. EQUIPMENT IT EQUIPMENT <br />COST ASSESSED COST ASSESSED COST ASSESSED <br />VALUE VALUE COSTEUED <br />VALUE <br />Current Values 0570000 3920000 1530000 1010000 WOOD <br />20000 1830000 <br />Plus estimated values of 10°° <br />Proposed <br />d ef0 am 70pDOp 700000 800000 <br />18000 18000 926120 328120 <br />bean <br />Less values or any properly being replaced <br />Net estimated values upon Completion of pmlecl 1270000 1620000 <br />2130000 1810000 /65000 38000 <br />x158420 481420 <br />- <br />Estimated solid waste converted (pounds) <br />Estimated hazardous waste converted (pounds) <br />Olherbene0ts: <br />I hereby certify that the representations in this statement are We. <br />Si9n8 nz•d reprba Tille Data eigne0 (month,d year) <br />_ <br />Page 1 of 2 <br />