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LF Il U= IS Ll <br />FORM S1311 / PP <br />MAY 0112023 We <br />RIVACY NOTICE <br />)allon concornln0 the son <br />Yn-+e•�A- �� rly and spealllo ealerloa pelA <br />to s_proyaes Uy Ilia V part' <br />LERK TREASURER fidential per IC a-1.1-12.1-5,1. <br />INSTRUCTIONSt <br />.1. This slateniorril must be subrriffloof to the body dersiffialing Ilia Economic Revilalizallon Area priorlo Ilia public hearing It Ilia designating body requires <br />Information from the appllcantln maiming Its decision about whetter to designers an Economic Revilalfzallon Area. Clherwlse ibis statement must be <br />subntfted to the deslpnaling body BEFORE person Inslella lite now manufacturing equipment and/or researchanddevelopment equipment, and/or <br />logistical distribution equipment and/or Infsfmation technology aquipmenf for which Ilia poison wishes to claim a deduction. <br />2. The slalemenl ofbene/Its form-musl be submilfad to Ilio designating body and Ilia area designated an economic revitalization area before the Installation of <br />qualifying sharable equipment for which the person desires to calm a deduction. <br />3. To obtain a deduction, a person mus( file a ced111ed deduction schedule will) the person's personal properly return on a codified deduction.sebedule <br />(Form 103 -ERA) with fhe (owashlpassessor of Ilio township where (he property Is situated or with the county assessor• If liters ratio township assessor for <br />fire township.. The f 03 -ERA must be Iliad between January i and May 16 or lite assessment year In which new manufacturing equipment and7orresearch <br />and development equfpmenbend/or loglstcal dlstdbulton aqulpment and/arInformation technology equipment is installed and fully functional; unless a filing <br />extension has been obtained. A person who obtains a filing extension inner file Ilio form between January 1 and Ilia extended due dale of Ilial year. <br />4. Property owners whose Statement of Bonefils. was opplevod,hint/ submit Form Cr-11PP annually to show compliance with the Statement of Benofils. <br />(1C 6-1.1-12.1-6.6) <br />6.. Fora rormSB-11PP(hat is approvodafterdime.90, 2013, Ilio designating body is requireat astabllsh an abatement schedule for each deduction allowed. <br />Fora Farm SS-1/PP thetls approved pdorto July 1, 201S, Ilio abatement schedule approved by the designating body remains in effect, (IC6-1.1-12.1-17) <br />SECTION•• <br />STATEMENT OF BENEFITS <br />PROPERTY <br />Name of laxpeyor <br />PERSONAL <br />Slate Form 51704 (R011-21) <br />Buffers USA, Inc. <br />Prescribed by the Department of Local f <br />LF Il U= IS Ll <br />FORM S1311 / PP <br />MAY 0112023 We <br />RIVACY NOTICE <br />)allon concornln0 the son <br />Yn-+e•�A- �� rly and spealllo ealerloa pelA <br />to s_proyaes Uy Ilia V part' <br />LERK TREASURER fidential per IC a-1.1-12.1-5,1. <br />INSTRUCTIONSt <br />.1. This slateniorril must be subrriffloof to the body dersiffialing Ilia Economic Revilalizallon Area priorlo Ilia public hearing It Ilia designating body requires <br />Information from the appllcantln maiming Its decision about whetter to designers an Economic Revilalfzallon Area. Clherwlse ibis statement must be <br />subntfted to the deslpnaling body BEFORE person Inslella lite now manufacturing equipment and/or researchanddevelopment equipment, and/or <br />logistical distribution equipment and/or Infsfmation technology aquipmenf for which Ilia poison wishes to claim a deduction. <br />2. The slalemenl ofbene/Its form-musl be submilfad to Ilio designating body and Ilia area designated an economic revitalization area before the Installation of <br />qualifying sharable equipment for which the person desires to calm a deduction. <br />3. To obtain a deduction, a person mus( file a ced111ed deduction schedule will) the person's personal properly return on a codified deduction.sebedule <br />(Form 103 -ERA) with fhe (owashlpassessor of Ilio township where (he property Is situated or with the county assessor• If liters ratio township assessor for <br />fire township.. The f 03 -ERA must be Iliad between January i and May 16 or lite assessment year In which new manufacturing equipment and7orresearch <br />and development equfpmenbend/or loglstcal dlstdbulton aqulpment and/arInformation technology equipment is installed and fully functional; unless a filing <br />extension has been obtained. A person who obtains a filing extension inner file Ilio form between January 1 and Ilia extended due dale of Ilial year. <br />4. Property owners whose Statement of Bonefils. was opplevod,hint/ submit Form Cr-11PP annually to show compliance with the Statement of Benofils. <br />(1C 6-1.1-12.1-6.6) <br />6.. Fora rormSB-11PP(hat is approvodafterdime.90, 2013, Ilio designating body is requireat astabllsh an abatement schedule for each deduction allowed. <br />Fora Farm SS-1/PP thetls approved pdorto July 1, 201S, Ilio abatement schedule approved by the designating body remains in effect, (IC6-1.1-12.1-17) <br />SECTION•• <br />Name of laxpeyor <br />Name of contaal person <br />Buffers USA, Inc. <br />Jack SISk <br />Address of taxpayer (number and street, olbl stele, tori 21Pco0o) <br />Telophone number <br />10180 New Berlin Road , Jacksonville FL 32226 <br />( 904 ) 696-0110 <br />Noma of deelonaling body <br />Resolution number (a) <br />Town of Mooresville <br />I - a6:x3 <br />Location of properly <br />County <br />DLGF Islas district number <br />9623 Haymaker Drive, Mooresville, IN 46158 <br />Morgan <br />Description of manufacturing ayyuipmant and/or research and development oqulhment ESTIMATED. <br />and/or to distribution andlor Information technology equipment.. <br />equlparent <br />-(Use adrll(tonal thesis If necessary,) <br />STA GATE COMPLETION DATE <br />Foridlfte and Pallet Racking used for distribution. <br />Manufacturing Equipment <br />R & D Equipment' <br />Logist Dist Equipment 0$/01/2023 06/30120124 <br />IT Equipment <br />Current Number Salarias Number ROlainod <br />Spadesflu-merAddlgunul &eludes <br />0 0 1 0 <br />1 0 15 71760Q.00 <br />sEc1rioN4 tSTIMATIED TOTAL COSTAND <br />• e•e -r <br />NOTE: Pursuant Pursuant to IC 6-1.1-12.1-5:1 (d) (2) the MAN UFA N C RMO <br />& <br />R DIT IT EQUIPMENT <br />D EQUIPMENT LO GISTMEN <br />COST of lire property is congdenllal. CA$T .ASSESSED <br />VALUE - <br />DOST ASSESSED COST ASSESSED. COST ASSESSED <br />VALUE VALUE VALUE <br />Current values <br />0 0 <br />0 <br />0 01 0 0 0 <br />Plus estimated Values of proposed Project <br />0 0 <br />0 <br />0 360,000 350,000 0 0 <br />Leos values of any property being replaced <br />0 0 <br />0 <br />0 0 0 0 0 <br />Net estimated values upon completion of project 0 0 <br />0 0 360,000 360,00!7 U 0 <br />• • cr 310 ' eFwRi;n <br />s Pnomfism BY'rHE TAXPAYER <br />Estimated solid Waste convened (pounds) <br />Estimated hazardous waste converted (pounds) <br />Olhar bonogts: <br />• <br />o <br />1 hereby certify that the representations in this statement ore true. <br />Signature of euintabod representative <br />Dale sl nod monln, daK year) <br />s .7" 1823 <br />Printed name or aetholizedrapre lative <br />'milia/r�a <br />4AZA )J <br />r <br />Page 1 of 2 <br />