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STATEMENT DF 13ENE0TS
<br />PERSONAL PROPERTY
<br />State -Form 54754IFU /12 ' 11.t
<br />r • Presorib.ad.. iyl,he Oepartmeni otLocal GoVemnient Finance
<br />IN TRL/OT1910-.
<br />FORM SBA i PP
<br />,PRIVACY NOTICIi;
<br />�T}��,,4 yrostapd�nY •specil(ciltdivtdllal's
<br />my infommalio • is abnifdaidial; the
<br />balancB cFthe- fil�ngYs "ptibllQ record
<br />pertC S i. t- 12.1 =5.1 • c and (d).
<br />1. This -staterrlent must be gdhinitted• to the body,designatfng the Econornk Revitalization AnMa Pilot to file public.hearingg.if the desfgnat!n4 body regr)fi;es
<br />infotmal/oh frog► the applfeant inmak(ity its deefsion abqut tYhether to: designate an"Ecisnomic Ravitalizallon A►ea; Othenvlse this stdt+#merit rrii►stlie sifbrrtHted
<br />to the designating.,6oiiy 81 <�OR�� pardon fgsla(ls tits;..new manufactGdng'egt/ipment andTorreseaPch and itet+elop/neert equfgmenf; •and /br7o�siia�l -dis`Irlbaifon
<br />eciulpmenfohd /orinforrtaatfon ech olpgy egulpmant for which #hg' .erson.wishes to claim a deducifon: P#oJegts "planned br irom»tltfe'd to afer July j, 49 &7,
<br />and aleas desfgriataii after Jufy 'jr 9'987, require. a STi.4TEi4ENT ViF BENENT.S (1C 1),
<br />2. Approval of the desfgnatfrig'body (Uly Council, rowlt -Board County Council, etc.) must be obtainedprlof.#oinstoliefion of thenbiOmanufacturing pgulpMent
<br />and /or research a!!d i/ ogrgliriieht etj(rlpmeni end or fogistfcal disfrlbution equfpmenf end/orinforniatl 1n, technology equipment, BEFORE a deifudfioii .may
<br />be approved
<br />3 To .obtain a de.ductlon, a POrso'n fngst fife a xeaig.d.dedu-ctio'n, schodgle. with lhs persot/ "s personal �rgpertyletum on a ce1ln"ied deduatfo{r setts "dule•(Fpmr
<br />103:ER4j with the #owttshfp essessdr of the tot+vns(rip whets tha property, is sif�7ated or With the ooAy_4ssassorff there Is no tdwriship hisses gifibetfre
<br />toWrishfp. The ib3- ERAmustbe fll�cJba Peen March f and May 1$nfthe assessinenf yearin Whfclr newmanepfuring agriipment and/orrer parch and
<br />developt»eitt`ecjuipfien# et)o%%rloy)sUcal oiisbulion equipment and/or Infor/rfati6h technclQgy eij7{flitneiitls insfelled and folly ftine�on�al, 'unless a fiing
<br />axfehsforr had beep obfaiited: A person who ob #sins a filing extension tpust'flle the. fdtm. 6etwseir Meech 9 -- end the extended due date bf th& year.
<br />F Property ok+ners whose Statement of Ben'sflho was approved after Juno 3t) 1991,.r0g4(eubmW Pbrm GF:1 % PP annually to s1.gW vomplfance v fh the
<br />tSf�ttemehf of Benefi(s. (it 6:9..1 -J2 1:5.6)
<br />t. The schedule's esteblt�hed underic 6 -1.1- 129- Atx(d) and (e) apply fi equipment rr+stalled after AUrch 1,.2001, unless ail alternative deductfon schedule is
<br />adapted by fhe desi-gnailnj b6dli (IC (1-111- 12.1 -11).
<br />SECTION •• YER INFORMATION
<br />Name of taxpayer
<br />South Bend Forin Tool Ina
<br />//Coou.,
<br />n�
<br />4Adc re Indif (aaxAv "8J eendglN 4� "t OFD' atale,.and ZIP code)
<br />Rayne of conlapt persod
<br />Tefsphone nurpber
<br />Herb Eggers
<br />674286.2441
<br />SECTION a • AND DESCRIPTION OF -• -• a PROJECT
<br />Name of designating body
<br />ResoTullon number (s)
<br />City of South Bend
<br />Locatlon•of property
<br />1616 81623 Franklin St., South Bend, IN 46613
<br />County
<br />Ist Joseph
<br />DLGF W-Atng dlstridt number,
<br />Description of tnanUtactui'ing a, b1prite4t,and/6r reseerch end deyelopment equipment
<br />ES fIMATED
<br />and /or Ibggist(cai distribution equ pmenl and/or informatidn technology irquipmOnT
<br />(uso additional sheets if necessaiy)
<br />START-DATE. COMPI;7!QN DATE
<br />Manufacturing 440ipm6nt
<br />3/1512016 12!1512017
<br />R & D Egyipti or t
<br />CNC Lathes, Wire ECM, Automatic Band Saw, Auto CMM, Tooling, Warehouse Raddng, PC's, ERP Software
<br />Logist Dist FgtQprnetit
<br />7/15!2016 11115/2016
<br />IT Egtfiprfinept
<br />7/15/2016 10/31/2017
<br />SECTIOW3 ESTIMATE OF • YEES AND SALARIES AS RESU LT OF -••• PROJECT
<br />Currentnumber Salaries Rumberrei$ined 5aades Numberadd@ional Salaries'
<br />17 $785,000 11 $7,000 B $378,560
<br />SECTION 4 ESTIMATED TOTAL COST AND VALUE OF PROPOSED PROJECT
<br />ti9AtVUFACTURiNG R & D EQUIPMENT LOGIST D* IP rr E
<br />NOTE-., Pursuaritiodt; 6 -1.1- 1,.2,9 -fi.1 (d) (2) the EQUIPMENT EQUIPfiftENT QUIPMENT
<br />COST di file property is confiaeii�tleL cbsrt ASSESSED COST' ASSESS i GO,ST ASS! SEED OOgt 4°SSESSI =D
<br />'VALUE. VAL VAll1E VALUE
<br />Curfetjivatiie's
<br />'
<br />-Plo .e3th ted values of propRged.pfojeot
<br />$623,077,
<br />;623,077
<br />$11,305 o
<br />$9,30o 0
<br />Less vaittes of "' y pTOperty..being remi)apeii
<br />N 3,077 $623,077
<br />$11,305 - n 89,300 0
<br />SECTION 5 WASTE CONVERTED AND OTHER BENEFITS
<br />PROMISED BY
<br />rr laied solid wastepFnyetted (pound$)
<br />f= sUrriate� hazefdous.weste converted (pounds)
<br />[Estl
<br />her` lia�etlis^
<br />SECTION CERTIFICATION
<br />I hereby certify that the represenletions_ to this statement are flue:
<br />3ighaturadfatithodzad 'representative ` t " oolagtW,2Yo;s4,nos oby 1Kella11 ro
<br />Ss.
<br />Title
<br />P.I.ot Manager
<br />Dte.sgneditonih,dayyead
<br />03 /03/2016
<br />rage ( of 9
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