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Filed in Clem • Office <br /> 1 <br /> ci%\iV Ii 4 201 <br /> STATEMENT OF BENEFITS FORM SB-1 /PP <br /> : i <br /> � PERSONAL PROPERTY CITY aAWN IVi.JC)iVES <br /> ] State Form 51764(R4/11-15) RK,Sot1TH Q�(��,IN <br /> ' <br /> 3yi <br /> Prescribed by the Department of Local Government Finance PRIVACY NOTICE <br /> Any information concerning the coat <br /> of the property and specific salaries paid <br /> to individual employees by the property <br /> owner is confidential per IC P 1.1-12.1.5.1. <br /> INSTRUCTIONS <br /> i. This statement must be submitted to the body designating the Economic Revitalization Area prior to the public hearing I/the designating body requires <br /> information from the applicant in making its decision about whether to designate an Economic Revitalization Area. Otherwise this statement must be <br /> submitted to the designating body BEFORE a person installs the new manufacturing equipment and/or research and development equipment,and/or <br /> logistical distribution equipment and/or information technology equipment for which the person wishes to claim a deduction. <br /> 2. The statement of benefits form must be submitted to the designating body and the area designated an economic revitalization area betore the installation <br /> of qualifying abatable 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 the 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 <br /> for the township. The 103-ERA must be filed between January 1 and May 16 of the assessment year in which new manufacturing equipment <br /> and/or research and development equipment and/or logistical distribution equipment and/or information technology equipment is Installed and fully <br /> functional,unless a filing extension has been obtained. A person who obtains a filing extension must file the form between January 1 and the extended <br /> due date of that year. <br /> 4. Property owners whose Statement of Benefits was approved,must submit Form Cf-1/PP annually to show compliance with the Statement of Benefits. <br /> (IC 6-1.1-12.1-6.6) <br /> 5. For a Form SB-t'/PP that Is approved alter June 30,2013,the designating body Is required to establish an abatement schedule for each deduction allowed. <br /> Fora Form 58-f/PP that is approved prior to July 7,2013,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 /> Greenlearklold Co. dba Pure Green Farms Joe McGuire,CEO , <br /> Address of taxpayer ikuteber end street,city state,and ZIP code) Telephone number <br /> 3820 W.C,alvert ( 863) 370-3154 <br /> SECTION 2 LOCATION AND DESCRIPTION OF PROPOSED PROJECT <br /> Name of designating body Resolution number(s) <br /> City of South Bend/St. Joseph County <br /> Location of properly Count DLGF taxing district number <br /> 3820 W. Calvert South Bend, IN 46613 St. Joseph 026 South Bend(Portage) t <br /> Description of manufacturing equipment and/or research and development equipment ESTIMATED , <br /> and/or logistical distrbutinn equipment and/or Information technology equipmert. START DATE COMPLETION DATE <br /> (Use adddional sheets if necessary) , <br /> Manufacturing Equipment 1/1/22 12/31/24 ; <br /> Please refer to supplemental sheet <br /> R&0 Equipment N/A N/A t <br /> Logist Dist Equipment N/A N/A <br /> IT Equipment 1/1/22 12/31/24 <br /> • <br /> SECTION 3 ESTIMATE OF EMPLOYEES AND SALARIES AS RESULT OF PROPOSED PROJECT t <br /> Current number Salaries Number retained Salaries %mbcr eddltlonal Salaries <br /> 25 1.65M/Yeah 23 1.65M/fear 75 2.73M/Year . <br /> SECTION 4 ESTIMATED TOTAL COST AND VALUE OF PROPOSED PROJECT <br /> NOTE:Pursuant to IC 6 1.1-12.1-5.1(d)(2)the MANUFACTURING R&D EQUIPMENT LOOtST DIET IT EQUIPMENT t <br /> EQUIPMENT EQUIPMENT <br /> COST of the property is confidential. COST ASSESSED COST ASSESSED COST ASSESSED COST ASSESSED <br /> VALUE VALUE VALUE VALUE <br /> Current values 21 M In Progress f lOK in Progress •• <br /> Plus estimated values of proposed project 70IV1 In Progress 101: In Progress • <br /> Less values of any property being replaced <br /> Net estimated values upon completion of• eject 91 M In Progress I ICK lu Progress I <br /> SECTION 5 WASTE CONVERTED AND OTHER BENEFITS PROMISED BY THE TAXPAYER 1 <br /> Estimated solid waste converted(pounds) VLit,;i lc dn;i'o_rc,,1n11 Estimated hazaraous waste converted(pounds) "`\ <br /> Other benefits: <br /> Please refer to supplemental sheet <br /> SECTION 6 TAXPAYER CERTIFICATION I <br /> I hereby certify that the pre.a atlons In uye st6enl are true. <br /> Signature of authorized re a .. :liv. / Date signed(month,day year) <br /> 1/10/21 <br /> Printed name of authorized n6ris- tallve Tale <br /> J.Jay Paciot , Director of Finance • <br /> Page 1 of 2 ' <br />