Laserfiche WebLink
Fihd;i ', tOffice <br />SEP L 1 2020 <br />yam, ` STATEMENT OF BENEFITS <br />a4 . _ PERSONAL PROPERTY <br />Slate Form 51764 N4111-15) I DAM <br />a r , Prescribed by the Department of Loral Government Firm1CITY CLERK. SOUTH 8 <br />FORM SB -1 I PP <br />'i• r PRIVACY NOTICE I <br />Any mlouration none ornin, u,, cos, <br />of the properly not spedr2 snlar� Paid <br />to individual employ.. by the property <br />INSTRUC77ONS. ovrrmr k mnlWaMhl per IC &1 r-tx, o -s 1 <br />1. This statement must be submitted to the body des'gnating the E040sno c Revitalization Ata prior to the public hearing If the designating body requires <br />mformet On from the appi(caid In making its decision about whefber to deslgnale an Economic Revhaihnite n Aura. Ofhenvisa this statement must be <br />Submitted to the designating body BEFORE as person installs the rtmv manufacturing equipment andror research and development equipfut and1w <br />logfsfka/ OlsbrbUtyon equiPmerf and/or information technology equipment for which the Person wishes to claim a deduction. <br />2. The statement of benefits form must be submitted M the deslgnoung hotly and the area designated an economic revitalization area before the installation <br />Ofqueidt abatable equipment for which the person desires In claim a deduction. <br />3. To obtain a deduction, a person must fife a cruto ed deduction schadille with the liaison's personal progeny mtum on a certified deduction schedule <br />(Form 1g3 -ERA) with the township assessor, of the township where the proPeny is situaled or with the county assessoriffhem is run township assessor <br />for the townsmp. The 103 -ERA must be filed between January i and May 15 of the assessment year in which rtew manufactu ut equipment <br />an0br reseamn and development equipment andsw logistical distribution equipment and/or informatmn technology equipment is installed and fully <br />Mndfenal, unless a flb'rg extension has been coffered. A person who Oblalns a filing extension must file the form between January 1 and the extended <br />due date of mat year <br />4. Prupony owners whose Statement of Benefits was approved, must submit Form CF1/PP annually to show compliance with the Statement of Benefits. <br />(IC 6-1.1-12.1-5.6) <br />5. Fora Form SB-11PPmat is approved aaer June 30. 2013, the designating body is required to establish an abatement schedule toveach deduch'on allowed. <br />Fora Form SB-I/PP that is approved priorfo July 1. 2013. the abatement schedule approved by the designating body remains in effect. (IC 6-1.1-12.1-17) <br />Tri-Pac, Inc. <br />Vik Sh h P <br />Addrem oltavpayer rnvm6er and sheet dry, s!a/e, and Zip code) <br />ram a , residWllt <br />3333 N Kenmore St, South Bend, IN 46628 <br />Teiephorle number <br />(574 )855-2197 <br />Name or desgneling body <br />South Bend City Council <br />Resolution number Is) <br />Location of property <br />4303 Technology Drive, South Bend, IN 46628 <br />County DLGFleang dietrdnumber <br />ST JOSEPH 009 <br />Description of manufacturing equipment andlor research aM development <br />equipment <br />and/or logistical distribution equipment Matter mfommilion technology equtpmem. ESTIMATED <br />(Use additional sheets if necessary.) <br />START DATE COMPLETION DATE <br />Manufacturing Equipment 9/15/2020 12/31/2021 <br />New Pharma/PPE equipment purchases. <br />R & D Equipment <br />LOgai Dist Equipment <br />IT Equipment <br />Cmrenl number Sonoma Number retained <br />0 <br />sale, Numberaddibamt Saltines <br />0 0 <br />0 20 $748.8 000 <br />• <br />a •ol• --• <br />NOTE: Pursuant to IC 6-1.1-12.1-5.1 (d) (2) the MANUFACTURING <br />R & D EQUIPMENT LOGIST DIST <br />COST of the property is confidential,COST A D <br />COST D COST ASSESSED ASSESSED <br />1�LS <br />Curren) values <br />VALUE VALUE VALUE <br />VALUE <br />Plus estimated values of reposed pro act 20000 0 600000 <br />Less values of any grope bein r aced <br />Net estimated values Won core Ilm of pro ect 20 <br />•10— 11 <br />a . <br />Estimated solid waste converted (pounds) <br />•c <br />Estimated hazardous waste converted (pounds) <br />Other benefrls: <br />SECTION 15 TAXPAYER <br />CERTIFICATION <br />I hereby worry that the repreaerltdllOn3 in this slate 11 are true, <br />Signature of a ed ni resent ! <br />r✓`��(' <br />Date signed (month, dap year) <br />August26,2020 <br />Printed name Or authorized representative <br />TI•e <br />Vikram Shah <br />President <br />Page I of 2 <br />