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F'ilod in'1Prk',s Office <br />SEP a-1 ZINO I <br />STATEMENT OF BENEFITS 1 L7;5)-A9V-N--M'-J'0-TTE—S—j <br />REAL ESTATE IMPROVEMENTSCITY GLtK SOUTH FEND, IN <br />State Form 51767 (R6 / 10.14) <br />Prescribed bythe Department of Local Government Finance <br />This statement is being compleed for reaIpropenythatclualifiesunder thefdloving Indana Code (check orebox): <br />® Redevelopment or rehabilitation Of real elate imprOvemeots (IC &1,1-12.1-4) <br />t3 Residentially distressed area (IC 6-1.1-12.1 A.1) <br />MSTRUCTIONS: <br />1. Thissfatenentrrustbesubnettedtodiebcdydwignatingne Ecmodc RevdalizationAreapriortoOepubfictx <br />Infomafionf mthewDli tlnmkinallsdecisionabmtwhattertodesiona'eanEcononicReveafaationAm <br />20 20 PAY2LZI <br />FORM SEA IReal Property <br />PRIVA YNO E <br />m ma ".a mare? ng t <br />oft he pidttroper lv <br />ands <br />pdaeIrificsalaries <br />popert Yao'xRiier aIsaxdidentialb peke <br />2. The slatemento/beneftsforrnmust besubnittedtothe designatingbodyandthaarea dasigrretedaneconomcrevdaltzation area before the inidatic <br />the mdeveloprent ormhabiffetion forwtachthe person desires to olaima deduction. <br />3. Toobteinadeductkan,a Fam322/RErrustbefdedwdhthe CounlyAuofrorbefreWylOintheyeainwtictitteadcitiontoassessedvaluationis <br />nodeornottaterthanttwtv(301daysaftertheass wmntao6ceisrreiedtothemmrlvawnerifdwasnailedaftwAodff0Aommdvowmrwh <br />4. ApropedyownwwhofYasforthededucticnnustpmvidethe ComtyAuddmarddesignatingbody Mi6 aFamCF-1/Reai Property. The FormCF-1/Rear <br />Propedyshould bealtachedtothe Fc m322/RE when the deductionis firstclaimed and Penupdatedannuadyforeach yearthe deduction is applicable. <br />lC 6-1.1-12.1$.1(6) <br />5. Fora Form SB-1/Rea' Pmpedyihatisappovedalkr June30,2013, the desgnadngbodyisrequired to establish an abaerrent schedule foreach <br />dedpcfivle9osved Fora Form SB-1/Rsal Propedythat is approved prior to July 1,2013, the abaenentscheduleppmuedbythe designating body <br />retrains in effect. IC 6-1.1-12.1-17 <br />SECTION 1 TAXPAYER <br />INFORMATION <br />Name mtavaver <br />ri-Pac, Inc. <br />Address of tavayer (number and street, dtV, slate, and ZIP code. <br />3333 North Kenmore Street, South Bend, IN 46628 <br />rre dfcDntact person Witram wn <br />lelephone number <br />I E-malladdress <br />574-855-2197 <br />vikram.shah@tri-pac.0 <br />SECTION 2 LOCATION AND DESCRIPTION <br />Name of desienadnb Body <br />OF PROPOSED PROJECT <br />Resp utaan numdar <br />South Bend City councillata! <br />an of property _ _-. <br />tax -Fa didistrictnumber <br />4303 Technology Ddee, South Bend, IN 46628Cganty <br />ST JOSEPH <br />009 <br />MWIPlIon a, real pulperty Improvements, "w1opment, or re ton t0r owulti <br />tsuntedstart clate (monlF dI <br />9/15/2020 <br />Building purchase with planned upgrades and modifications <br />to R&D lab/equipment. <br />Estooted mrryletron date (monl , ay,Ye <br />12/31/2021 <br />SECTION 3 ESTIMATE OF r SALARIESAS <br />RESULT OF PROPOSEDR <br />Cuaentnumhar Salaries Numbe-reta:ned <br />s <br />5:,hd.+ Nurnbe,addidonal Seems <br />0 0 <br />0 20 $748,800.00 <br />SECTION 4 ESTIMATED TOTAL COSTAND <br />VALUE OF PROPOSED PROJECT <br />REAL ESTATE IMPROVEMENTS <br />COST I ASSESSEDVALUE 1 <br />it %dues <br />Plusestimatedvaluesotproposedproject <br />I <br />1$1,000,000 1$1,000,000 <br />I Le$valuesofanvompertybelmmpLa d <br />I <br />Net estimated values SIco lellon <br />I$1,0130.0DO <br />SECTION e e AND OTHER <br />BENEFITS PROMISED BY THE TAXPAYER <br />Estimated sclidwaste convected O o "&sa) ---- — ----- <br />Estimated h mrdous waste converted (pounds) <br />Other benefits <br />SECTION <br />I hereby vTy that one representations to t Is statement are true. <br />August 26, 2020 <br />Vikram Shah <br />President <br />Page 1 of 2 <br />