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Filed in Clerk's Office <br /> JUL 0 5 2023 <br /> + <br /> �_ ` STATEMENT OF BENEFITS —.... M.JONES ` FORM SB-1 I PP <br /> '',' t ' PERSONAL PROPERTY <br /> • , t CITY CLERK,SOUTH BEND,iN PRIVACY NOTICE <br /> State Form 51764 R5 r;-211 <br /> :• .,, / Prescribed by the Department of Local Government Finance <br /> n.. Any information concerning the cost <br /> of Ise property and specific salaries paid <br /> to individual employees oy the property <br /> owner is confidential Der IC 5-1.1-12.1-5 1 <br /> INST.RUCTIONS- <br /> 1 This statement must be submitted to the body designating the Economic Revitalization Area poor to the uubiic hearing if the designating body requires <br /> Information from the applicant rn making its decision snout whether to designate an Economic Revitalization Area Ornery/6'e this statement must be <br /> submitted to the designating body BEFORE a parson,nstalls the new manufacturing equipment and/or research and development equioment,and/or <br /> cgst.cai distribution equipment ard'or:nfor:nation technology equipment for which the person wishes to claim a deduction <br /> .- roe statement of benefits form must be submitted to fie designating body and the area designated an economic revitatr7anon area before the installation of <br /> quelif y'ng abnfable equipment for which the person desires to claim a deduction <br /> 3 To obtain a deduction,a person must file a certified deduction schedule with toe person's personal property return on a certified deduction schedule <br /> (Form 103-ERA)with the township assessor of the township where the property is situated or with the county assessor if there is no township assessor for <br /> the township. The 103-ERA must be filed between January 1 and Mai 15 of the assessment year in which new manufacturing equipment and/or research <br /> and development equipment and/or logistical distribution equipment and/or information technology equipment is installed and fully functional unless a filing <br /> extension has been obtained A person who obtains a filing extension must file the form between January t and the extended due date of that year <br /> 4 Properly owners whose Statement or Benefits was approved,must submit Form CF-1,PP annually to show compliance with the Statement of Benefits. <br /> (IC 6-1 1-12 1-5 6) <br /> 5 For a Form SE-1/PP that is approved atter June 30,2013.the designating body is required to establish an abatement schedule for each deduction allowed <br /> For a Form SE-1/PP that is approved pont to July 1,2013 the abatement schedule approved by the designating body remains in effect IC 6-1 1-12 1-17) <br /> SECTION 1 TAXPAYER INFORMATION <br /> Name of taxpayer Name of contact person <br /> Crossroads Solar Enterprises LLC PirsiNamr Patrick Las:Name: Regan <br /> Andress of taxpayer Telephone number Eaad <br /> .,inib,Aodtiln!cf, 1901 N. Bendix Dr South Bend <:,:r. IN err 46628 (607)759-1058 .•e.•1.0»••..•• <br /> SECTION 2 LOCATION AND DESCRIPTION OF PROPOSED PROJECT <br /> Name of designating body Resolution number(s1 <br /> Common Council of the City of South Bend <br /> Location of property County DLGF taxing district number <br /> N,.,,,„. ,i S <br /> ;uri-crl. <br /> 1901 N. Bendix Dr r,;,. South Bend se,,,.IN sit, 46628 St.Joseph 026(South Bend-Portage) <br /> Description of manufacturing equipment and/or research and development equipment ESTIMATED <br /> and/or logistical distribution equipment and/or information technology equipment. START DATE COMP_ETIGN DATE <br /> 'S.:Se additional sheets if necessary? <br /> The equipment is a fully automated solar panel assembly Manufacturing Equipment <br /> line. It will include a laminator, sun simulator, framing, R 3 D Equipment <br /> soldering unit and numerous conveyors. This equipment <br /> will increase our productive capacity by 4X. Logist Dist Equipment <br /> IT Equipment <br /> SECTION 3 ESTIMATE OF EMPLOYEES AND SALARIES AS RESULT OF PROPOSED PROJECT <br /> Current Number Salaries Number Retained Salaries Number Additional Salaries <br /> 14 $ 582,400 14 $ 582,400 15 $750,000 1 <br /> SECTION 4 ESTIMATED TOTAL COST AND VALUE OF PROPOSED PROJECT <br /> NOTE:Pursuant to IC 5-1.t-.2 1-5 1(d)(2i the <br /> MANUFACTURING R&D EQUIPMENT LOGIST DIST IT EQUIPMENT <br /> E• IPMEt1T _ EQUIPMENTCOST of the property is confidential. COaI- ASSESSED COST 'ASSESSED COST ASSESSED cosi- ASSESSED i <br /> VAI UE VALUE VALUE VA_LIE <br /> Current values s o <br /> Plus estimated values of proposed protect $1.000,000 <br /> I.ens values of any property being replaced $0 <br /> Net estimated values upon completion of project $'Orto ono $o ; $0 $0 6 0 . $0 $0 $0 <br /> SECTION 5 WASTE CONVERTED AND OTHER BENEFITS PROMISED BY THE TAXPAYER <br /> Estimated sdnrl waste converted i},, J G I Estimated hazardous waste converted;wards) 0 <br /> Other benefits —: <br /> SECTION 6 TAXPAYER CERTIFICATION <br /> I hereby fy that th• representat this statement are.. <br /> Sigratur of dud,ed.-.res t five Gale Au d RAM.day year) <br /> c)t7 <br /> �rtrt' ''►/t�ta�of aaustharted enrcs-..yy']0 /^1 � Title <br /> Page 1 of 2 <br />