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STATEMENT OF BENEFITS <br />UW. PERSONAL PROPERTY <br />State Form 51764 (R2/ 12 -11) <br />Prescribed by the Department of Local Government Finance <br />INSTRUCTIONS: <br />FORM SB -1 / PP <br />PRIVACY NOTICE <br />The cost and any specific individual's <br />salary information is confidential; the <br />balance of the filing is public record <br />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 must be 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 committed to after July 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 />and /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 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 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, 1991, must submit Form CF -1 / PP annually to show compliance with the <br />Statement of Benefits. (1C 6 -1.1- 12.1 -5.6) <br />5. The schedules established under 1C 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 (1C 6- 1.1- 12.1 -17). <br />SECTION •- • <br />Name of taxpayer <br />Mossberg & Company, Inca. <br />st t <br />30 dEast Sampl epStreeI�n5outhe�e^nddlNreb�60 ty, state, and Z!P code) <br />Name of contact person <br />James Hillman <br />Telephone <br />p one number <br />574-269 -9253 <br />Name of designating body <br />South Bend Common Council <br />Resolution number (s) <br />Location of property <br />301 East Sample Street, South Bend, IN 46601 <br />County <br />DLG DLG F laxin g district number <br />St. Joseph <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 />START DATE <br />COMPLETION DATE <br />(use additional sheets if necessary) <br />Manufacturing Equipment <br />1/1/2016 <br />3/1/2017 <br />R & D Equipment <br />Mossberg & Company, Inc. proposes to Invest in new manufacturing/bindery equipment <br />Logist Dist Equipment <br />IT Equipment <br />99urrent number Salaries Number retained Salaries Number additional <br />$5,071,5DD/yr 99 $5,071,500/yr <br />Salaries <br />2 <br />$100,000 /year <br />NOTE: Pursuant to IC 6 -1.1- 12.1 -5.1 (d) (2) the MANUFACTURING R & D EQUIPMENT LOGIST DIST <br />EQUIPMENT <br />if EQUIPMENT <br />EQUIPMENT <br />COST of the property is confidential. COST ASSESSED D COST ASSESSED D COST ASSESSED <br />VALUE <br />COST <br />ASSESSED <br />VALUE <br />Current values 18,161,806 $5,448,540 <br />Plus estimated values of proposed project <br />$25DM$3DOM <br />Reg. 16 <br />Less values of any property being replaced <br />0 <br />0 <br />Net estimated values upon completion of project <br />18,411,806+ <br />Reg. 16 <br />Estimated solid waste converted (pounds) <br />Estimated hazardous waste converted (pounds) <br />Other benefits: <br />CERTIFICATION SECTION 6 TAXPAYER <br />I Wr.Qby certify that the representations in this statement are true. <br />Signalur of a horized repre a la' a <br />Title <br />Date signed (month, d y, year <br />t'VEIV� <br />President & CEO <br />` _ <br />( / Page 1 of 2 <br />V <br />