Your Input is Required in all Yellow Areas

Please complete the Supporting Schedules first (this page).

Your totals from these schedules will automatically be incorporated
into the Income and Expense form.

PLEASE CALL IF YOU HAVE ANY QUESTIONS OR COMMENTS

Eric Kassoff, Esquire (202) 457-7805
Ken Max, Esquire (202) 457-7811
Kevin Kozlowski, Esquire (202) 457-7825
Emily Betsill, Esquire (202) 457-7890
Rhett Tatum, Esquire (202) 457-7824

INCOME AND EXPENSE

SUPPORTING SCHEDULES (HOTEL/MOTEL)

NAME AND LOCATION OF PROPERTY OWNER AND ADDRESS OF RECORD

Tax Account No(s).:

REVENUE FROM OPERATIONS 2017 2018 2019

3. Other Income

Totals: $ - $ - $ -

4. Retail Tenants

Totals: $ - $ - $ -

DEPARTMENTAL EXPENSES

7. Other Costs

Totals: $ - $ - $ -

UNALLOCATED EXPENSES:

8. Administrative Costs

Totals: $ - $ - $ -

11. Maintenance & Repairs

Totals: $ - $ - $ -

18. Reserves for Replacements

Totals: $ - $ - $ -

19. Capital Expenditures

Totals: $ - $ - $ -
 HOTEL/MOTEL INCOME QUESTIONNAIRE
FOR THE 36 MONTHS FROM 2017 to 2019

NAME AND LOCATION OF PROPERTY OWNER AND ADDRESS OF RECORD

0 0
0 0
0 0
0 0
Tax Account No(s).: 0

Total Number of Rentable Ro _____________________ Number of Parking Spaces: __________

2017 2018 2019

Average Rate/Room/Day $ - $ - $ -
Average Number of Rooms Occupied/Day - - -
Percentage of Occupancy for the Year 0.0% 0.0% 0.0%
RevPAR (Revenue per Available Room) $ - $ - $ -
Total # of Beds _____________________ Annual Occupancy Rate _____________________

Please attach a current Balance Sheet for personal property and defined intangible assets with assigned values.

REVENUE FROM OPERATIONS: 2017 2018 2019

1. Room Rentals
2. Food & Beverage
3. Other Income (List) $ - $ - $ -
4. Retail Tenants (List) $ - $ - $ -

DEPARTMENTAL EXPENSES: (Cost of Goods Sold, Departmental Wages, etc.)

5. Rooms
6. Food and Beverage
7. Other Costs (List) $ - $ - $ -

UNALLOCATED EXPENSES:
8. Administrative Costs (List) $ - $ - $ -
9. Marketing
10. Electricity & Utilities
11. Maintenance & Repairs (List) $ - $ - $ -
12. Insurance
13. Management Fee
14. Franchise Fees

OTHER EXPENSES:
15. Real Estate Taxes
16. Building Depreciation
17. Mortgage Interest Payment
18. Reserves for Replacements (List) $ - $ - $ -
19. Capital Expenditures (List) $ - $ - $ -
20. Furniture, Fixtures & Equipment Total Values
21. Other Intangible Values Assigned

MORTGAGE/SALES INFORMATION:
1. Is there a current mortgage on the property? Yes ( ) No ( ) If Yes, please provide the following data:

________________________________ ___________________ ____________ ________________

Name of Mortgagee Mortgage Amount Interest Rate Term of Mortgage

2. Please Provide: Date Purchased ______________ Consideration _________________________

3. Is there a lease or management agreement? ( ) Yes ( ) No

If so, summarize the terms and conditions of the agreement ty( ) Management ( ) Lease ( ) Sale-Leaseback
Lessee or Management Company ________________________________ Date ____________ Term ____________ Fee _________________

4. Please summarize the terms and conditions of the franchise agreement:

Franchise Co. __________________________________ Date ____________ Term ____________ Fee _____________________________

5. Personal Property Account Number ____________________________________ Entity Name: _______________________________________

I declare, under the penalties of perjury, that the contents of this form and all the accompanying schedules and
statements have been examined by me and are true, correct, and complete to the best of my knowledge, information, and belief.

_____________________________ _____________________________ ___________________

Owner's Signature Title of Signer Date

___________________________________________________ ________________________
Print/Type Name of Signer Phone Number