Fillable Form 2019: City of Danbury Assessors Office (City of Danbury)

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Form 2019: City of Danbury Assessors Office (City of Danbury)

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BROWSE CITY OF DANBURY (CT) FORMS

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Return to the Assessor’s Office on or Before August 15, 2020
The Assessor’s Office is required by law to revalue all property in the City of Danbury every five years. In order to assess your real property fairly and
equitably, information regarding the income and expenses related to your property is essential. Connecticut General Statute §12-63c requires all owners
of rental property to annually file income and expense statements to the assessors office. Any information related to the actual rental and rental-related
income and operating expenses
shall not be a public record and is not subject to the provisions of Connecticut General Statute 1-210 (Freedom of
Information Act).
Please complete the enclosed forms and return them to this office on or before August 15, 2020. In accordance with Connecticut General Statute
§12- 63c(d), any owner of rental real property who fails to file this form or files an incomplete or false form with intent to defraud shall be subject to a
penalty assessment equal to a ten percent (10%) increase in the assessed value of such property.
GENERAL INSTRUCTIONS - Complete this form for all rented or leased commercial, retail, industrial, or combination property. Identify the
property and address. Provide Annual information for the calendar year 2019. TYPE/USE OF LEASED SPACE: Indicate use the leased space
being utilized (i.e., office, retail, warehouse, restaurant, garage, etc.). ESC/CAM/OVERAGE: (Circle if applicable) ESCALATION: Amount, in
dollars, of adjustment to base rent either pre-set or tied to the Inflation Index. CAM: Income received from common area charges to tenant for common
area maintenance, or other income received from the common area property. OVERAGE: Additional fee or rental income. This is usually based upon
a percent of sales or income. PROPERTY EXPENSES & UTILITIES PAID BY TENANT: Indicate the property expenses & utilities that are the
responsibility of the tenant. Abbreviations may be used (i.e., “RE” for real estate taxes & “E” for electricity). VERIFICATION OF PURCHASE
PRICE must be completed if the property was acquired after January 1, 2017.
WHO SHOULD FILE - All individuals and businesses receiving this form should complete and return this form to the Assessor’s Office. If you
believe that you are not required to fill out this form, please call the number listed above to discuss your special situation. All properties which are
rented or leased, including commercial, retail, industrial and residential properties, except “such property used for residential purposes, containing not
more than six dwelling units and in which the owner resides,” must complete this form. This report must be file when a property is partially rented and
partially owner-occupied.
IF YOUR PROPERTY IS 100% OWNER-OCCUPIED, OR 100% LEASED TO A RELATED CORPORATION, BUSINESS, FAMILY
MEMBER OR OTHER RELATED ENTITY, PLEASE INDICATE BY CHECKING THIS BOX  AND RETURN THIS FORM WITH THE
SIGNATURE PAGE SIGNED & DATED.
HOW TO FILE - Each summary page should reflect information for a single property for the year of 2019. If you own more than one rental property, a
separate
report/form must be filed for each property in this jurisdiction. An income and expense report summary page and the appropriate income
schedule must be completed for each rental property. Income Schedule A must be filed for apartment rental property and Schedule B must be filed for
all other rental properties.
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Postmark NOT Accepted p
er C.G.S. – FAXED co
pies NOT Accepted per C.G.S
2019
Annual Income and
Expense Report
RETURN TO:
Danbury Assessors Office
155 Deer Hill Avenue
Danbury, CT 06810
TEL (203) 797-4556
FAX (203) 796-1651
City of Danbury Assessors Office
If you have any questions concerning these forms or the information required, please call this office at (203) 797-4556.
,03257$177,36
2019 Annual Income and Expense Report Summary
Owner ___________________________________________ Property Name _________________________________________________
Mailing Address ___________________________________________ Property Address _________________________________________________
City / State/ Zip ___________________________________________ Check here if property is 100% Owner Occupied
1. Primary Property Use (Circle One) A. Apartment B. Office C. Retail D. Mixed Use E. Shopping Center F. Industrial G. Other ______________
2. Gross Building Area
(Including Owner-Occupied Space) _______________ Sq. Ft. 6. Number of Parking Spaces ____________________
3. Net Leasable Area _______________ Sq. Ft. 7. Actual Year Built ____________________
4. Owner-Occupied Area _______________ Sq. Ft. 8. Year Remodeled ____________________
5. No. Of Units _______________
INCOME - 2019 EXPENSES - 2019
9. Apartment Rental (From Schedule A) ____________________ 21. Heating/Air Conditioning ____________________
10. Office Rentals
(From Schedule B) ____________________ 22. Electricity ____________________
11. Retail Rentals
(From Schedule B) ____________________ 23. Other Utilities ____________________
12. Mixed Rentals
(From Schedule B) ____________________ 24. Payroll (Except management, repair & decorating) ____________________
13. Shopping Center Rentals
(From Schedule B) ____________________ 25. Supplies ____________________
14. Industrial Rentals
(From Schedule B) ____________________ 26. Management ____________________
15. Other Rentals
(From Schedule B) ____________________ 27. Insurance ____________________
16. Parking Rentals ____________________ 28. Common Area Maintenance ____________________
17. Other Property Income ____________________ 29. Leasing Fees/Commissions/Advertising
________________
____
18. T
OTAL POTENTIAL INCOME (Add Line 9 Through Line 17) ____________________ 30. Legal and Accounting ____________________
19. Loss Due to Vacancy and Credit ____________________ 31. Elevator Maintenance ____________________
20. E
FFECTIVE ANNUAL INCOME (Line 18 Minus Line 19) ____________________ 32. Security ____________________
33. Other
(Specify)____________________ ____________________
34. Other
(Specify)____________________ ____________________
35. Other
(Specify)____________________ ____________________
36. T
OTAL EXPENSES (Add Lines 21 Through 35) ____________________
37. N
ET OPERATING INCOME (Line 20 Minus Line 36) ____________________
38. Capital Expenses ____________________
39. Real Est
ate Taxes ____________________
40. Mortga
ge Payment
(Principal and Interest) ____________________
41. Depreciation ____________________
42. Amortization ____________________
RETURN TO THE ASSESSOR ON OR BEFORE AUGUST 15, 2020 TO AVOID 10% PENALTY
Clear ALL Form Data
$ 0
$ 0
$ 0
$ 0
SCHEDULE A – 2019 APARTMENT RENT SCHEDULE Complete this Section for Apartment Rental activity only.
UNIT TYPE NO. OF UNITS ROOM COUNT
U
NIT SIZE
S
Q. FT
M
ONTHLY RENT
T
YPICAL
L
EASE TERM
T
OTAL
R
ENTED
R
OOMS
B
ATHS
ER
NIT
T
OTAL
EFFICIENCY
1 BEDROOM
2 BEDROOM
3 BEDROOM
4 BEDROOM
OTHER RENTABLE UNITS
OWNER/MANAGER/JANITOR OCCUPIED
S
UBTOTAL
GARAGE/PARKING
OTHER INCOME (SPECIFY)
T
OTALS
SCHEDULE B - 2019 LESSEE RENT SCHEDULE Complete this section for all other rental activities except apartment rental.
N
AME
OF
T
ENANT
L
OCATION
OF
L
EASED
S
PACE
T
YPE
/U
SE
OF
L
EASED
S
PACE
L
EASE
T
ERM
A
NNUAL
R
ENT
P
ROPERTY
E
XPENSES
& UTILITIES
P
AID BY TENANT
S
TART
DATE
E
ND
DATE
L
EASED
SQ. FT.
B
ASE
RENT
E
SC
/C
AM
/
OVERAGE
T
OTAL
RENT
R
ENT PER
SQ. FT.
TOTAL
Copy and Attach If Additional Pages are Needed
B
UILDING
F
EATURES
I
NCLUDED IN
RENT
(Please Check All That Apply)
Heat Garbage Disposal
Electricity Furnished Unit
Other Utilities Security
Air Conditioning Pool
Tennis Courts Dishwasher
Stove/Refrigerator
Other Specify _____________________
&YBNQMF#PCT1MVNCJOH
6OJU%
Retail
mm/dd/yyyy
mm/dd/yyyy
1,500 $18,000
0
$18,000
$12
Electric, gas
Clear Schedule A
$ 0.00
$ 0.00
$ 0.00
$ 0.00
$ 0.00
$ 0.00
$ 0.00
0
0
0
0
0
0
$ 0.00
0
0
0
0
0
0
$ 0.00
Clear Schedule B
$ 0.00
$ 0.00
$ 0.00
$ 0.00
$ 0.00
$ 0.00
$ 0.00
$ 0.00
$ 0.00
$ 0.00
$ 0.00
$ 0.00
$ 0.00
$ 0.00
$ 0.00
$ 0.00
$ 0.00
$ 0.00
0
$ 0.00
0
$ 0.00
$ 0.00
VERIFICATION OF PURCHASE PRICE
PURCHASE PRICE $____________________ DOWN PAYMENT $____________________ DATE OF PURCHASE ___________________
FIRST MORTGAGE $______________ INTEREST RATE __________% PAYMENT SCHEDULE TERM _________YEARS
SECOND MORTGAGE $______________ INTEREST RATE __________% PAYMENT SCHEDULE TERM _________YEARS
OTHER $______________ INTEREST RATE __________% PAYMENT SCHEDULE TERM _________YEARS
DID THE PURCHASE PRICE INCLUDE A PAYMENT FOR: Furniture? $______________ EQUIPMENT? $______________ OTHER (SPECIFY) $______________
(VALUE) (VALUE) (VALUE)
WAS THE SALE BETWEEN RELATED PARTIES? (CIRCLE ONE): YES NO
WAS AN APPRAISAL USED IN The Purchase OR FINANCING? (CIRCLE ONE): YES NO
APPROXIMATE VACANCY AT DATE OF PURCHASE _______%
APPRAISED VALUE /NAME OF APPRAISER_________________
_______________
PROPERTY CURRENTLY LISTED FOR SALE? (CIRCLE ONE) YES NO
IF YES, LIST THE ASKING PRICE $___________________ DATE LISTED ___________________ BROKER ______________________
Remarks - Please explain any special circumstances or reasons concerning your purchase (i.e., vacancy, conditions of sale, etc.)________________________________
____________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________
RETURN TO THE ASSESSOR ON OR BEFORE August 15, 2020 TO AVOID 10% PENALTY
(Check One)
Fixed
Variable
I DO HEREBY DECLARE UNDER PENALTIES OF FALSE STATEMENT THAT THE FOREGOING INFORMATION, ACCORDING TO THE
BEST OF MY KNOWLEDGE, REMEMBRANCE AND BELIEF, IS A COMPLETE AND TRUE STATEMENT OF ALL THE INCOME AND
EXPENSES ATTRIBUTABLE TO THE ABOVE IDENTIFIED PROPERTY (Section §12-63c (d) of the Connecticut General Statutes).
SIGNATURE ______________________________ NAME (Print) ______________________________ DATE _________________________
TITLE ______________________________ TELEPHONE ______________________________
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Form 2019: City of Danbury Assessors Office (City of Danbury)

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Completed 18 January 2021

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