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*ff' STATEMENT OF BENEFITS <br />VACANT BUILDING DEDUCTION <br />State Form 55182 (R 12 -14) <br />Prescribed by the Department of Local Government Finance <br />This statement is being completed for real property that qualifies as an "eligible vacant building" as defined by <br />IC 6 -1.1- 12.1 - 1(17). <br />20_ PAY 20_ <br />FORM SBA I VBD <br />PRIVACY NOTICE <br />The cost and any spegYC individual's <br />salary information is confidential; the <br />balance of the fling is public record <br />per IC 6 -7.1- 72.7 -SA (c) and (d). <br />INSTRUCTIONS: <br />1. This statement must be submitted to the body designating the Economic Revitalization Area prior to the public heating if the designating body <br />requires information from the applicant in making its decision about vrhether 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 322111BD 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 after April 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 -1NBD to show compliance <br />with the approved Form SB -1N9D. The Form CFINBD must also be updated each yearin which the deduction is applicable. <br />SECTION •- <br />Name of taxpayer <br />Ts K �r r� E1ELOP E� %, 1 x.�SCVTi/,V4LO, e_1 <br />Address of taxpayer (numberand street, city, state, and ZIP code) <br />247 North Dixieway, South Bend, IN 46637 <br />Name of contact person <br />Telephone number <br />E -mail address <br />AJ Patel <br />( 574 ) 387 -4467 <br />info @jskhotel.com <br />SECTION 2 LOCATION AND DESCRIPTION <br />OF PROPOSED PROJECT <br />Name of designating body <br />Resolution number <br />South Bend Common Council <br />Location of property <br />County <br />DLGF taxing district number <br />111 St. Joseph St., South Bend, IN 46601 <br />St. Joseph <br />Description of eligible vacant building that the property owner or tenant wh occupy (use additional sheets ifnecessery). <br />Estimated occupancy date (month, day, year) <br />Hall of Fame building <br />Xuts4.57- 1, a0 /,5- <br />Estimated date placed -in -use (month, day, year) <br />A ec,v 1 a017 <br />sr:cTiON 3 ESTIMATE OF EMPLOYEES <br />AND SALARIES AS A RESULTOF PROPOSED PR <br />Current number Salaries <br />Number retained Salaries Numberadditional Salaries <br />0 0.00 <br />0 0.00 38 1,108,723.20 <br />SECTION ESTIMATED <br />TOTAL COST AND VALUE OF PROPOSED PROJECT <br />REAL ESTATE IMPROVEMENTS <br />COST <br />ASSESSED VALUE <br />Current values <br />2,400,000.00 <br />Plus estimated values of proposed project <br />500,000.00 <br />Less values of any property being replaced <br />Net estimated values upop completion of project 2,400,000.00 <br />SECTION •- TO SELL OR LEASE VACANT BUILDING <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 forwhbh the building 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 6 TAXPAYER CERTIFICATION <br />I hereby certify that the representations in this statement are true. <br />Signature of autho' ealalive <br />Ttie <br />Date signed (month, day, year) <br />INI4eMt10Q!' <br />May 12, 2015 <br />Page 1 of 2 <br />