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STATEMENT OF BENEFITS 20 PAY 20_ <br /> VACANT BUILDING DEDUCTION <br /> a <br /> State Form 55182(R/2-14) FORM SB-1/VBD <br /> Prescribed by the Department of Local Government Finance <br /> PRIVACY NOTICE <br /> This statement is being completed for real property that qualifies as an"eligible vacant building"as defined by The cost and any specific individual's <br /> IC 6-1.1-12.1-1(17). salary information is confidential;the <br /> balance of the filing is public record <br /> per IC 6-1.1-12.1-5.1(c)and(d). <br /> INSTRUCTIONS: <br /> I. This statement must be submitted to the body designating the Economic Revitalization Area prior to the public hearing if the designating body <br /> requires information from the applicant in making its decision about whether to designate an Economic Revitalization Area. Otherwise,this statement <br /> must be submitted to the designating body BEFORE the occupation of the eligible vacant building for which the person wishes to claim a deduction. <br /> 2. To obtain a vacant building deduction,a Form 3221VBD must be filed with the county auditor before May 10 in the year in which the property owner <br /> or his tenant occupies the vacant building or not later than thirty(30)days after the assessment notice is mailed to the property owner if it was <br /> mailed afterApril 10. If the property owner misses the May 10 deadline in the initial year of occupation,he can apply between March 1 and May 10 <br /> of a subsequent year <br /> 3 A property owner who files the Form 3221VBD must provide the county auditor and the designating body with a Form CF-1/VBD to show compliance <br /> with the approved Form SB-1/VBD. The Form CF-1/VBD must also be updated each year in which the deduction is applicable. <br /> SECTION • • <br /> Name of taxpayer I, _ <br /> SS K UEUF–e–c, 7E^�T, 1n7C./SONTh'Ho�, G <br /> Address of taxpayer(number and street,city,state,and LP code) <br /> 247 North Dixieway,South Bend, IN 46637 <br /> Name of contact person Telephone number E-mad address <br /> AJ Patel ( 574 ) 387-4467 info @jskhotel.com <br /> SECTION 2 LOCATION AND DESCRIPTION OF PROPOSED PROJECT <br /> Name of designating body Resolution number <br /> ( <br /> South Bend Common Council � S 6— ( r <br /> Location of property County DLGF taxing district number <br /> 111 St.Joseph St.,South Bend,IN 46601 St.Joseph <br /> Description of eligible vacant building that the property owner or tenant will occupy(use additional sheets if necessary). Estimated occupancy date(month,day,year) <br /> iq <br /> Hall of Fame building use4-57 4 a0%s- <br /> Estimated date placed-in-use(month,day,yead <br /> SECTION 3 ESTIMATE OF EMPLOYEES AND SALARIES AS A RESULT OF PROPOSED PROJECT <br /> Current number Salaries Number retained Salaries Number additional Salaries <br /> 0 0.00 0 0.00 38 1,108,723.20 <br /> ESTIMATED SECTION TOTAL COST AND VALUE OF PROPOSED PROJECT <br /> REAL ESTATE IMPROVEMENTS <br /> COST ASSESSED VALUE <br /> Current values 2,400,000.00 <br /> Plus estimated values of proposed project 500,000.00 <br /> Less values of any property being replaced <br /> Net estimated values upon completion of project 2,400,000.00 <br /> SECTION • TO SELL OR <br /> Described efforts by the owner or previous owner to sell,lease,or rent the building during period of vacancy: <br /> City had call for offers for sale or lease <br /> Show amount for which the budding was offered for sale,lease,or rent during period of vacancy. <br /> $2,400,000 for sale;$9/sq.ft.for lease <br /> List any other benefits resulting from the occupancy of the eligible vacant building. <br /> SECTION • <br /> I hereby certify that the representations in this statement are true. <br /> Signature ofnature of ht>o autd FeprexMaGve Title Date signed(month,day,year) <br /> `YI42 O-LtO/ May 12,2015 <br /> Page 1 of 2 <br />