<p> 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</p><p>Pho Civi ne c num addr ber ess</p><p>Cell Pro num pert ber y Em nam ail </p><p>Lease Details and Income Information:</p><p>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</p><p>Ex. John's Pizza 2 1-Jan-10</p><p>1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>7</p><p>8</p><p>9</p><p>10</p><p>Total</p><p>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</p><p>O Ex $ 1,750 $ 7,500 Security $ 15,750 $ 5,000 $ R 1,500</p><p>O 1 R</p><p>O 2 R</p><p>O 3 R</p><p>O 4 R</p><p>O 5 R</p><p>O 6 R</p><p>O 7 R</p><p>O 8 R</p><p>O 9 R</p><p>O 10 R</p><p>Completed by Signature Date completed Comments</p><p>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</p>