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Filod in .^,le,rk's Office <br />SEP 17 ZO20 <br />^a STATEMENT OF BENEFITS �q�/NM. 0 Est <br />e REAL ESTATE IMPROVEMENTS CIT1 CLt I( 5G. 0 S <br />State Form 51767 (R6 / 10-19) , IN <br />I Prescribed by the Department of Local Govemmen(Finance <br />Thisstalement isbeing completed farealpmpenythatqualifimunderthefdlowirg Indiana Code (check one box): <br />® Redevelopment amhabililaton of real edge improvements (IC 6-1.1-12.1A) <br />❑ Residentially distressed area (IC 6-1.1-12.14.1) <br />INSTRUCTIONS: <br />1. ThisstaterrentrrustbambtdttedtoMebolvdecionatinarhe Ecanonic Revitalization Amanriormmenuhlich <br />2. The staterrentofbenelnsformiust besubaittedto thedesignafingbody andtheareadesignatedaneconone <br />the mdevelopmnt orrehobifilationtorwNchthe person desires to clatma deduction. <br />3. To obtains deduction, a F=322/RE must be fled with the CountyAuclforbetare May 10 intheyearin which <br />4. <br />2020 PAY20JI <br />FORM SB -1 IReal Property <br />PRIVACYN TI E <br />Any Iat on mnrer ng t tart <br />olthe proper) y a nd specifi c salaries <br />paldta indiudualemdoyees bythe <br />property ovmer IsmnB6den[ial per <br />1.-121-. <br />wishes <br />10. <br />Propedyshoukd beattachedtothe Form3221RE whenfhecieduction is firstdaw ed andlhenupdatedmnwlytoreach yearthe deduction isapplicable. <br />IC 6-1.1-12.15.1(b) <br />5. Fora Form SB-1/Rea Pmpedyfhatisappmvedatler June 30, 2013. the desgmdngbcdyismquiredtoestablisp an abatement schedule toreach <br />deduclioaeEowed. Fora Form SB-1/Rea Propedythat is approved prior to July 1,2013. the abatement schedule approved bythe designating body <br />rens rosin effect. IC 6-1.1-12.1-17 <br />SECTION•. <br />Nacre a tagaser <br />Tri-Pac, Inc. <br />Address of taxpayer (number and street, dyi, state, and ZIP ode) <br />3333 North Kenmore Street, South Bend, IN 46628 <br />Mine or comactperson Warm Snan <br />telephonenumber <br />E-mah address <br />( i 574-855-2197 <br />vikram.shah@tri-pac.0 <br />SECTION 2 LOCATIONAND DESCRIPTION <br />Name of downs inb body <br />OF PROPOSED PROJECT <br />Remi.utwn num er <br />South Bend City Council <br />location of waperty <br />County <br />oLGF taang dlstnct num r <br />4303 Technology Drive, South Bend, IN 46628 <br />ST JOSEPH <br />009 <br />MWImOn 01 (eal property i w Doman , ar re a can <br />r ry7- <br />E$tLwlld Stan date mon ay, Year <br />9/15/2020 <br />Building purchase with planned upgrades and modifications <br />to R&D lab/equipment. <br />Estimated tanowon date(month, day, ye <br />12/31/2021 <br />SECTION 3 ESTIMATE OF EMPLOYEES • SALARIES <br />AS RESULT OF PROPOSED PROJECT <br />P:r.ant number Selanas Num:ere. .a ne' <br />s <br />4:da:ie+ Number •dditpnal Saknes <br />0 <br />'� 20 $748,800.00 <br />TOTALSECTION 4 ESTIMATED <br />•• • PROJECT <br />REAL ESTATE IMPROVEMENTS <br />COST ASSESSEDVALUE <br />i it <br />C�aenl clues <br />Pluse3i matedvaluesofpreposed project 1$1,000,000 <br />x$1,000,000 1 <br />Leava l uesof anvprooenv b ema replaced <br />Net estimated values upon com letion of Wgect j$1,000,wo <br />$1,000,000 <br />SECTION 5 WASTE CONVERTED AND OTHER <br />BENEFITS PROMISED BY THE TAXPAYER <br />Estimated solidwaste converted (pounds)--------- <br />Estimated haardous vas(e converted (pounds) <br />Other benefits <br />SECTION 6 TAXPAYER CERTIFICATION <br />I hereby cent y [ attfie representations in this statement are true. <br />August 26, 2020 <br />Vikram Shah <br />President <br />Page 1 of 2 <br />