18-43 Modifying and Reconfirming Resolution for JSK Developmemnt (Ireland Hospitality- Holiday Inn Express)

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STATEMENT OF BENEFITS 20 15 PAY 20 16 REAL ESTATE IMPROVEMENTS — — State Form 51767(R6/10-14) FORM SB-1 1 Reai Property Mme Prescribed by the Department of Local Government Finance PRIVACY NOTICE This statement is being completed for real property that qualifies under the following Indiana Code(check one box): Any information concerning the cost ❑Redevelopment or rehabilitation of real estate improvements(IC 6-1.1-12.1-4) of the property and specific salaries ❑Residentially distressed area(IC 6-1.1-12.1-4.1) paid to individual employees by the pproperty owner is confidential per INSTRUCTIONS: IC 6-1.1-12.1-5.1. 1. This statement must be submitted to the body designating the Economic Revitalization Area prior to the public hearing if the designating body requires information from the applicant in making its decision about whether to designate an Economic Revitalization Area. Otherwise,this statement must be submitted to the designating body BEFORE the redevelopment or rehabilitation of real property for which the person wishes to claim a deduction. 2. The statement of benefits form must be submitted to the designating body and the area designated an economic revitalization area before the initiation of the redevelopment or rehabilitation for which the person desires to claim a deduction. 3. To obtain a deduction,a Form 3221RE must be filed with the County Auditor before May 10 in the year in which the addition to assessed valuation is made or not later than thirty(30)days after the assessment notice is mailed to the property owner if it was mailed afterApri110. A property owner who failed to file a deduction application within the prescribed deadline may rile an application between March 1 and May 10 of a subsequent year 4. A property owner who files for the deduction must provide the County Auditor and designating body with a Form CF-1/Real Property The Fromm CF-1/Real Property should be attached to the Form 322/RE when the deduction is first claimed and then updated annually for each year the deduction is applicable. IC 6-1.1-12.1-5.1(b) 5. For a Form SB-11Rea1 Property that is approved after June 30, 2013, the designating body is required to establish an abatement schedule for each deduction allowed. For a Form SB-11Real Property that is approved prior to July 1, 2013, the abatement schedule approved by the designating body remains in effect. IC 6-1.1-12.1-17 SECTION •- • Name of taxpayer IRELAND HOSPITALITY LLC Address of taxpayer(number and street,city,state,and ZIP code) 247 DIXIE WAY NORTH, SOUTH BEND IN 46637 Name of contact person Telephone number E-mail address A.J. PATEL ( 574 ) 320-2784 ajpatel97 @yahoo.com SECTION 2 LOCATION AND DESCRIPTION OF PROPOSED PROJECT Name of designating body Resolution number _ SOUTH BEND CITY COUNCIL �Fl Location of property County DLGF taxing district number WEST END CALLANDAR ST., SOUTH BEND, IN ST. JOSEPH Description of real property improvements,redevelopment,or rehabilitation(use additional sheets if necessary) Estimated start date(month,day,year) EXISTING BUILDINGS WILL BE REMOVED AND REPLACED WITH A 4 STORY,81 ROOM HOLIDAY INN JULY 1, 2015 EXPRESS.THE NEW HOTEL WILL HAVE A CONFERENCE FACILITY,A BUSINESS CENTER,AN INDOOR Estimated completion date(month,day,year) POOL AND A FITNESS ROOM. JUNE 30, 2016 1Current number Salaries Number retained Salaries Number additional Salaries 0.00 1 $0.00 0.00 $0.00 /y 1 $305,000.00 REAL ESTATE IMPROVEMENTS COST ASSESSED VALUE Current values 5el,3CP0, Plus estimated values of proposed project 6.000,DOO.00 Less values of any property being replaced Net estimated values upon completion of project Estimated solid waste converted(pounds) O.00 Estimated hazardous waste c ~ .$) y F, Other benefits Joklit CITY CLERK,S0UTH BEND,IN CERTIFICATION SECTION 6 TAXPAYER I hereby certify that the representations in this statement are true. Signature of authorized representative Date signed(month,day,year) 5/26/2015 I P' ame of authorized represent e Title I ANANT PATEL MEMBER Page 1 of 2 6