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w.. <br /> <.,R� STATEMENT OF BENEFITS <br /> I y° '_' PERSONAL PROPERTY FORM SB-1 /PP <br /> ! State Form 51764(R2/12-11) <br /> Prescribed by the Department of Local Government Finance 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 /> INSTRUCTIONS; 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. (!C 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. (IC 6-1.1-12.1-5.6) <br /> 5. The schedules established under IC 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(IC 6-1.1-12.1-17). <br /> SECTION 1 TAXPAYER INFORMATION <br /> Name of taxpayer <br /> Mossberg&Company,Inc. <br /> Address of taxpayer(number and street city,state,and ZIP code) <br /> 301 East Sample Street,South Bend,IN 46601 <br /> Name of contact person <br /> James Hillman Telephone number <br /> 574-289-9253 <br /> SECTION 2 LOCATION AND DESCRIPTION OF PROPOSED PROJECT <br /> Name of designating body <br /> South Bend Common Council Resolution number(s) <br /> Location of property I County <br /> 301 East Sample Street,South Bend,IN 46601 DLGF taxing district number <br /> St.Joseph 71026 <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 /> Manufacturing Equipment 1/1/2016 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 /> SECTION 3 ESTIMATE OF EMPLOYEES AND SALARIES AS RESULT OF PROPOSED PROJECT <br /> Current number Salaries Number retained Salaries <br /> 99 $5,071,500/yr 99 55,071,500tyr 2umberaddilional Salaries <br /> 5100,000/year <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 /> EQUIPMENT EQUIPMENT IT EQUIPMENT <br /> COST of the property is confidential. COST ASSESSED ASSESSED <br /> VALUE COST VALUE COST ASSESSED COST ASSESSED <br /> VALUE VALUE <br /> Curren(values <br /> $18,161,806 $5,448,540 <br /> Plus estimated values of proposed project $250M-5300M Reg.16 <br /> Less values of any property being replaced o 0 <br /> Net estimated values upon completion of project 518.411.806+ Reg.16 <br /> SECTION 5 WASTE CONVERTED AND OTHER BENEFITS PROMISED BY THE TAXPAYER <br /> Estimated solid waste converted(pounds) L Estimated hazardous waste converted(pounds) <br /> Other benefits: <br /> SECTION 6 TAXPAYER CERTIFICATION <br /> I r by certify that the representations in this statement are true. <br /> Signaler- of a horized regrew tat' e Title <br /> � , / i Date signed(month,day,year) <br /> `dy- v_ I President&CEO <br /> _ <br /> ( <br /> Page 1 of 2 <br /> 'J <br />