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STATEMENT OF BENEFITS <br />PERSONAL PROPERTY <br />State Form 51764 (R 11-06) <br />Prescribed by the Department of Local Government Finance <br />FORM SO-1) PP <br />PRIVACY NOTICE <br />The cost and any speck lnd�MUafs <br />salerykio maron{s«Malentat the <br />balance of the anya is Public record <br />INSTRUCTIONS: per IC 61.1- YY.7.5.1 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 mafdng its decision about whetherto designate an Economic Revitalization Area. Otherwise Cris statement must be subm)Med <br />to the designating body BEFORE a person Installs Me new manufacturing equipmentand/ornesearoh and development equipment and/orlogis" distribution <br />equipment and/or/nfomtation technology equipment for which the person wishes to claim a deduction. Pro)ectS- planned or committed to sterJuly 1, 1987, <br />and areas designated after fuly 1, 1987, require a STATEMENT OF BENEFITS. (IC 6 -L1 -12.1) <br />2. Approval of Me designating body (City Council, Town Board, County Council, etc.) must be obtained prior to Installation of the newmonufachrring equipment <br />and /or research and development equipment and/orlogistical distribution equipment end/orinformation technology equipment, BEFORE* 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. The 103 -ERA must be filed between March 1 and May 15 of the <br />assessment year in which new manufacturing equipment and/or research and development equipment and/or logistical distribution equipment and/or <br />Information technology equipment is installed and fully functional, unless a filing extension has been obtained. A person who obtains a filing extension must <br />rile the form between March 1 and the extended due date of that year. <br />4. Property owners whose Statement of Benerds was approved after June 30, 1991, must submit Form CF -I / PP annually to show compliance with the <br />Statement ofBene6ts. (IC 6-1.1- 12.1 -5.6) <br />S. The schedules established under IC 6- 1.1- 12.1- 4.5(d) and (e) apply to equipment installed after March 1, 2001. For equipment Instilled prior to March 2, <br />2001, the schedules and statutes in eMact at the time shaft continue to apply. (IC 6-1.1- 12.1 -4.5(n and (g)) <br />!q•IS•IR - - <br />Name of taxpayer <br />South Bend Gear, LLC <br />Address of taxpayer (number and street, city, state, and ZlPcrode) <br />3849 Showerlux <br />r <br />JAN 2 8 20 11 <br />Drive, South Bend, Indiana 46628 <br />Name of contact person Telephone number <br />Stan Blenke JOHN VOORDE ' (574) 234 -4116 <br />SECTION • a <br />Name of designating body Resolution n'unmber (a) <br />South Bend Common Council Fr— r I <br />Location of property <br />County DLGF taxing district number <br />3849 Showerlux Drive, South Bend, Indiana 46628 <br />St. Joseph 71 -009 <br />Description of manufacturing equipment and/or research and development equipment <br />and /or logistical distribution equipment and /or information technology equipment. ESTIMATED <br />(use additional sheets if necessary) START DATE COMPLETION DATE <br />See attached 2 Sheets. Manufacturing Equipment 07/01/2011 06/30/2013 <br />R & D Equipment <br />Logist Dist Equipment <br />IT Equipment <br />Cunenl number Salaries Numberretained Salaries Number additional <br />Saledes <br />0 0.00 0 0.00 12 <br />550,000.00 <br />SECTION 4 ESTIMATED TOTAL COST AND VALUE OF PROPOSED PROJECT <br />NOTE: Pursuant to IC 6.1.1- 12.1 -5.1 (d) (2) the MANUFACTURING R & D EQUIPMENT LOGIST DIST <br />E UIPMENT <br />fT EQUIPMENT <br />EQUIPMENT <br />COST of the property is confidential. COST ASSESSED COST ASSESSED COST ASSESSED <br />COST ASSESSED <br />VALUE VALUED <br />Current values <br />VALUE <br />o.00 o.ao <br />0sao.000.00 0.00o.aoo.co <br />Plus estimated values of proposed project <br />t <br />Less values of any property being replaced <br />o.00 0.00 <br />Net estimated values upon completion of project 15,600,000.00 6.240.000 DO <br />SECTION • s AND OTHER BENEFITS <br />PROMISED <br />Estimated solid waste converted (pounds) <br />Estimated hazardous waste converted (pounds) <br />Other benefits: <br />Total employees to be hired is estimated to be 26 by the completion date. <br />SECTION G <br />TAXPAYER CERTIFICATION <br />I hereby certify that the representations In this statement are true. <br />Signature of auMorized representeWe <br />- <br />Title <br />Date signed (momh, day yea0 <br />I <br />Manager <br />01/28/2011 <br />