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STATEMENT "OF B'ENE'F'1TS <br />PERSONAL PROPERTY <br />State Form 51764,(F(91'12-11) <br />Prescribed -1504 Department of Local Qovemrnefit Finance <br />A)KM S'8-1 I PP <br />PRIVACY NOTICE <br />The dbdap4any%bc1#0hqMdyaI's <br />isoliryinformation a <br />a conridentlat ft <br />"lz!tq qf!h9Jl#qg is pyblic record' <br />JN$TR1JC'r19NS. (d). <br />• <br />1. This'st6tembht Must be sUbmItted to Jha bo4ycresignaftng the <br />Information thdrri the 6-p' Economic Revitalization Areh prior to the -public. hearing.1f the designating body. raqdios <br />pJh;;WtZnMa;kt)# its d@c1slon.about whether to designate an E6oromlg'li?eviIa1!jatJ0rJ i6# be submitted <br />to the designating body BEFOREeperson Installs the newmanuAWOdnig equipment andWrfteatch anddevelop <br />mentequipment, and1drido J-dis?dbidon <br />, N <br />IY6.q"qlp'mp'r)df'o'rwfflih.thopersgn.Wishes to claim �a de6c6oh. 'Pr9Jeqts-p1annedor t6 ;0,july 1, 1947, <br />and after July *1, 1987, require a STATEMENT OF BENEFITS. (IC committed <br />2. Approval of the designating Wdy (City Cobnak Town Board County Council, etc.) must be o btsJnedpfio).(6 installation of the new nanificuring &quloant andlor research and <br />development. e4vlpmenfandlbr logistical distribution equipment eindlor Information technology equipment BEFORE a <br />ba approved deoudlon May <br />3. To obtain a dedu6tion, ;a Pbt6oh Must B16 a codft.d.deduction schedule with the Person's Personal 010peffy return on a ce4led deduction shh6dule {Fpnn <br />103-ERA) With the township assessor of the township wrishl <br />p mhere'the properly is 'situated or kh there Is no to*4shi6aisasi6r for the <br />township. 7;he, 163-ERA fijdit be nlio an March 9" and May 1.4 oriho iwossm6iii year In Which" na.W manabduring egPIPiveint &hd?brrii6arqh and <br />'iinsialleddhdkliyiu;ldtid�ai,'uni4ii' <br />devel6pffieril e4ul*i4b�dkk !94104ol Oislitbullon equipment and4or lnibrldailkh technology eqFp1p1nvht 14 <br />ext6nsloh h been , ob d. A a filing <br />'e* iaIie. . perq9n who ob a filing exteriaJoh niust'filat & -and &a #Xtorcfed due da <br />.o fbimbetwopr? March I <br />te of that year. <br />4. Property owners whose Statement of Benefits was approVbd aftdr June 3Q, 1991,. Must. subm# Porm CF-1 / PP annually to 81IOW compliance with the <br />5. 7h6 schedule's W601100 a7d6rlc &1,1 429 4.5(d) and () apply to equipment IfistaAW after Mzirch 1,.26ol, unless, an alternative deduction is <br />adopted by tlI6 qesfgnaft j6dj tip 0-1.1. 92.1 -17). 11b.n <br />1 <br />SECTION I TAXPAYER INFORMAT(ON <br />Name of rr - <br />S th BenftToolCo., Inc. <br />&re% if tax a rare <br />08 W state, vodz#';o;) <br />.IV '0416q4 wly, <br />,1%n <br />Name of contact person --j5TeT'41-1p8�92441 <br />a <br />Herb Eggers Tale hone number <br />Name of designating body <br />City of South Bond Resolution number (.q) <br />Location of property <br />1619 & 1623 Franklin SL, South Band, IN 46613 <br />ng distdrA number <br />County DLOF taxi SLJosiph <br />I <br />Description offnanUt ot(irihoeqfjiorh6litandlar research and oeyeloprrlentequ'pment <br />I'M <br />and/.orlbgisUcaldisitibu'tion'6quipmehl-iind/0rinformEitidnte6hno!6gyoLeioMIOAIL ESTIMATED <br />(use ad.d[Wonal-sheeis itnecessaty STA DATE COMPLETION n-El <br />Manufacturing ipm t <br />M. ctur g Eq <br />Manufacturinb 44Uiptrept 3/15=16 1211&MI7 <br />U en <br />!DEq <br />M711612016 <br />R 8, <br />R & D Eti4lipthent <br />JJpM.nt <br />E H <br />CNC Lathes, Wire EDM, Automatic Band Saw, Auto CMM, Tooling, Warehouse Racking, PCs, ERP Software <br />-'-'i <br />L'gl't D. ' j - . t <br />'st.Equ Pmen <br />Ldglet Distg44!P fit -1/1&2016 1 . 1115/2016 <br />IT Eq.0proent. 711512016 10*112017 <br />1 <br />11419 W-�- K�z W-m-413WHIM-1 41affols <br />Current number $alaries Number refaline Salaries Numlieradditional Salaries <br />17 $785,000 17 <br />$785,000 <br />$378.560 <br />TIMOR <br />NOTE: Pursuafit to (d) (9) MANUFACTURING R&DEQU LOGI DI$T IT EQUIPMENT <br />EQUIPMENT. EQUIPMENT <br />Q <br />EQUIPMENT <br />COST of the property Is conlid6nflal. C ASSESSW ASSESSED <br />[ASSESSED COST VALtle <br />IT <br />C OST ASSESSED ED <br />VALUE COST ASSESSED <br />VALUE <br />VALUE <br />Cillrof <br />-Plu$ 6aUrn6tbo'v#1ups of Propoped Project.. <br />$623,077 <br />$623,077 <br />$11.305 0 <br />$11.305 0 $000 <br />0 <br />Lo;ip vajOe;; of kny proprlybolng replaced <br />Net ekslimaied YalugswWoom0le0n <br />$M.077 <br />- <br />"'Prx's 1$62-%M <br />$11.3,5 <br />$11,305 .10 $9,300 <br />0 <br />Estimated Sohdwas.te.ronverW ( pounds). Estimated hazardous WOS(e converted (pounds) <br />Other tienetTts; .. <br />SECTION 6 TAXPAYER CERTIFICATION <br />I hereby certify that the repre—senikit opp in thts stateindrit are true; <br />Signalu. Of i�ooftedepresenavvs 0 Ct1W1y*ndhyKy1..- <br />*to— <br />Date 6-Ignbd (ffionih. pa� <br />A� ye, at) <br />MaW.2 016.03.03 11*3&56-W 01Y <br />Project Manager <br />J0310M2016 <br />Page f of 1 2 <br />