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SCHEDULE OF DEDUCTION FROM ASSESSED VALUE POOL 5 PROPERTY IN ECONOMIC REVITALIZATION AREA
State Form 52498 (R4 / 2-09)

MARCH 1, 2009 FORM 103 - P5 / ERA
PRIVACY NOTICE: The records in this series are confidential according to I. C. 6-1.1-35-9.

Prescribed by the Department of Local Government Finance INSTRUCTIONS: 1. 2. 3. 4.

In order to receive a deduction, this schedule must be submitted with Form 103-Long. A separate schedule must be completed for each approved abatement (Form SB-1/PP). Attach a copy of the applicable approved Form CF-1 to this schedule. For any acquisitions since the last assessment date, attach a list of the new equipment that is included on Form 103-EL. SECTION 1 TAXPAYER INFORMATION
Federal Identification number

Name of taxpayer Full address (number and street, city, state, and ZIP code) County Contact person Township Title

DLGF Taxing District number Telephone number ( )

SECTION 2
Name of body designating the Economic Revitalization Area Date designation approved (month, day, year)

ECONOMIC REVITALIZATION AREA INFORMATION
Resolution number Length of abatement (Years)

Date designation will terminate (month, day, year)

Does resolution limit dollar amount of deduction? YES - and limit is based on equipment Cost or Assessed Value

NO

SECTION 3

SCHEDULE OF POOLED EQUIPMENT UNDER ABATEMENT

The total cost of depreciable assets is to be reported on form 103-Long. This schedule includes only the new manufacturing, research and development, logistical distribution and/or information technology equipment that is deductible per the resolution and IC 6-1.1-12.1. Election to report cost of Depreciable Assets by Federal tax year ...................................................... Yes No * If taxpayer elects to report cost on a federal tax year basis, assets acquired from the end of the prior federal tax year to March 1 are reported on the first line. True Tax Value Abatement POOL NUMBER 5: TTV % [per 103-P5 or per IC 6Deduction Claimed Deduction Approved (Pursuant to IC 6-1.1-3-23) Year Percent 1.1-12.1-4.5 (f)] **

01 02 03 04 05 06 07 08 09 10 11

from 3-2-08 3-2-07 3-2-06 3-2-05 3-2-04 3-2-03 3-2-02 3-2-01 3-2-00 3-2-99
SECTION 3

to to to to to to to to to to to

3-1-09* 3-1-09 3-1-08 3-1-07 3-1-06 3-1-05 3-1-04 3-1-03 3-1-02 3-1-01 3-1-00

TOTAL POOL NUMBER 5

40% $ 40% 56% 42% 32% 24% 18% 15% 15% **40% **40% $

1 1 2 3 4 5 6 7 8 9 10 --

%$

$

--

$

$

SPECIAL TOOLING UNDER ABATEMENT True Tax Value [per 103-P5 or per IC 61.1-12.1-4.5 (f)] ** Abatement Year Percent Deduction Claimed Deduction Approved

Round all figures to the nearest $1. Report only cost of abatable special tools, dies, jigs, etc. (50 IAC 4.2-6-2)

True Tax Value of Acquisitions

3-2-08 3-2-07 3-2-06 3-2-05 3-2-04 3-2-03 3-2-02 3-2-01 3-2-00 3-2-99

to 3-1-09* to 3-1-09 to 3-1-08 to 3-1-07 to 3-1-06 to 3-1-05 to 3-1-04 to 3-1-03 to 3-1-02 to 3-1-01 to 3-1-00

TOTAL SPECIAL TOOLS

30% $ 3% 3% 3% 3% 3% 3% 3% 3% **30% **30% $

1 1 2 3 4 5 6 7 8 9 10 --

% $

$

--

$
OR AV $ $

$

TOTAL POOL 5 AND SPECIAL TOOLING LIMIT ON AMOUNT OF ABATEMENT STATED IN RESOLUTION Cost $ AMOUNT OF DEDUCTION CLAIMED (Lesser of Limit on Abatement and Total of Pools) Check if taxpayer has also filed Form 103 and 103 ­ ERA with Property in Pools 1, 2, 3 or 4.

$