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STATEMENT OF BENEFITS <br />�..; REAL ESTATE IMPROVEMENTS <br />+ ' State Form 51767 (R6110 -14) <br />Prescribed by the Department of Local Government Finance <br />This statement is being completed for real property that qualifies under the following Indiana Code (check one box): <br />❑ Redevelopment or rehabilitation of real estate improvements (IC 6- 1.1- 12.1 -4) <br />❑ Residentially distressed area (IC 6- 1.1- 12.1 -4.1) <br />INSTRUCTIONS: <br />1. This statement must be submitted to the body designating the Economic Revitalization Area prior to the public hearing if 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 the redevelopment orrehabWation of real property 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 before the initiation of <br />the redevelopment orrehabirtation for which the person desires to claim a deduction. <br />3. To obtain a deduction, a Form 3221RE must be tiled with the CounlyAuditorbefore May 10 in the yearin which the addition to assessed valuation is <br />made or not later than thirty (30) days after the assessment notice is mailed to the property owner if it was mailed afterApol 10. A property owner who <br />failed to file a deduction application within the prescribed deadline may rile an application between March 1 and May 10 of a subsequent year. <br />4. A property owner who riles for the deduction mustprovide the CountyAuditor and designating body with a Form CFf/Real Property. The Form CF -1 /Real <br />Property should be attached to the Form 3221RE when the deduction is first claimed and then updated annually for each year the deduction is applicable. <br />IC 6 -1.1- 12.1 -5. f(b) <br />5. For a Form SB- !/Real Property that is approved after June 30, 2013, the designating body is required to establish an abatement schedule for each <br />deduction allowed. For a Form SB- !/Real Properly that is approved prior to July 1, 2013, the abatement schedule approved by the designating body <br />remains in effect. IC 64.1 - 12.1 -17 <br />IRELAND HOSPITALITY LLC <br />Address of taxpayer (number andstreet, city, state, and ZIP code) <br />247 DIXIE WAY NORTH, SOUTH BEND IN 46637 <br />Name of contact person <br />Telephone number E -mail address <br />A.J. PATEL ( 574 ) 320 -2784 ainatp[ 7nvphnn n n <br />SOUTH BEND CITY COUNCIL <br />I Location of property County DLGF faxing district number <br />WEST END CALLANDAR ST., SOUTH BEND, IN ST. JOSEPH <br />EXISTING BUILDINGS WILL BE REMOVED AND REPLACED WITH A 4 STORY, 81 ROOM HOLIDAY INN <br />EXPRESS. THE NEW HOTEL WILL HAVE A CONFERENCE FACILITY, A BUSINESS CENTER, AN INDOOR <br />POOL AND A FITNESS ROOM. <br />W11 <br />1 11 <br />tsumated start date (month, day, <br />JULY 1, 2015 <br />stimated completion date (moult <br />JUNE 30, 2016 <br />fiber additional Salaries <br />Illy $305,000.00 <br />Page 1 of <br />REAL ESTATE IMPROVEMENTS <br />COST ASSESSED VALUE <br />S 300 <br />6,000,000600 <br />Current values <br />Plus estimated values of proposed project <br />Le ss values of any property being replaced <br />6,OSz/, 30 p <br />Net estimated values upon completion of project <br />Estimated solid waste converted (pounds) 0.00 <br />Estimated hazardous waste q{gd:0 00 rfyk• s <br />Other benefits <br />—j"-'e <br />yT <br />2015 <br />JOHat <br />CITY CLERK, SOUTH BEND, IN <br />Page 1 of <br />