Income and Expense Information
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Leasable Income and Expense Information Please complete or correct the following information. (Both sides) Income Year: Mun e icip ality Con tact Roll nam num e ber
Pho Civi ne c num addr ber ess
Cell Pro num pert ber y Em nam ail
Lease Details and Income Information:
1. Please show any vacant areas as a tenant along with size of vacant area in "Area Leased" 2. Please owner a tenant area in Page 1 of 2 No of Tenant No Lease Start Tenant/Business Months Date Name Vacant
Ex. John's Pizza 2 1-Jan-10
1
2
3
4
5
6
7
8
9
10
Total
To with a copy out financial statement form [email protected] online b.ca please go http:/ /ww w.gov .mb.c a/ia/ asses sment /ques tionna ires.h tml Please email this form along Operating Expense Details: Please enter the dollar amount for each expense type if owner pays applicable expense Enter dollar amount beside O if owner pays the expense and it is not recovered from the tenant, or R if the expense is recovered. NOTE: Recoverable expense income should be entered on page 1 Snow and Cleaning and Property Building Garbage Janitorial Property Maintenance Total Tenant Electricity Heat/Gas Sewer/Water Taxes Insurance Removal Wages Management Other Expenses Expenses Number and Repair
O Ex $ 1,750 $ 7,500 Security $ 15,750 $ 5,000 $ R 1,500
O 1 R
O 2 R
O 3 R
O 4 R
O 5 R
O 6 R
O 7 R
O 8 R
O 9 R
O 10 R
Completed by Signature Date completed Comments
To fill out this form online please go to t http://www.gov.mb.ca/ia/assessment/questionnaires.html Please email his form along with a copy of your financial statement to [email protected] Page 2 of 2