CITY OF WATERBURY
ANNUAL INCOME AND
CITY OF WATERBURY
235 GRAND STREET
WATERBURY, CT 06702
TEL: (203) 574-6821
FAX: (203) 574-6992
FILING INSTRUCTIONS. The Assessor’s Office is preparing for a revaluation of all real property located in Waterbury. In order to assess
your real property equitably, information regarding the property income and expenses is required. Connecticut General Statutes 12-63c
requires all owners of rental real property to annually file this report. The information filed and furnished with this report will remain
confidential and is not open to public inspection. Any information related to the actual rental and operating expenses shall not be a public
record and is not subject to the provisions of Section 1-19 (Freedom of Information) of the Connecticut General Statutes.
Please complete and return the completed form to the Waterbury Assessor’s Office on or before June 1, 2021.
In accordance with Section 12-63c(d), of the Connecticut General Statutes, as amended, 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. In accordance with the CGS, Sec 12-63b, as amended, upon determination that there
is good cause, the assessor may grant an extension of not more than thirty days to file such information, if the owner of such property
files a request for an extension with the assessor not later than May First.
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 2020. ESC/CAM/OVERAGE: (Check 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 for the common area property. OVERAGE:
Additional fee of rental income. You may attach to the completed form, a copy of your 2020 Federal Income Tax Returns, Schedule E
(Form 1040) Supplemental Income and Expenses and/or Form 8825, Rental Real Estate Income and Expenses of a Partnership, an S
Corporation or Limited Liablility Company (LLC) with the Form K-1 attached. You need not provide other tax schedules not related to the
rental activity. Complete VERIFICATION OF PURCHASE PRICE information.
WHO SHOULD FILE. All individuals and businesses receiving this form should complete and return this form to the Assessor’s Office. All
properties that 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. If a non-
residential property is partially rented and partially owner-occupied this report must be filed.
If you have any questions, please call (203) 574-6821.
OWNER OCCUPIED PROPERTIES. If your property is 100% owner-occupied you still must return this form. However, please report only
the income or expense items associated with occupancy of the building and land. Income and expense relating to your business should not be
HOW TO FILE. Each summary page should reflect information for a single property for the year 2020. 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. A computer printout is acceptable for Schedule A and B, providing all the required
information is provided.
RETURN TO THE ASSESSOR ON OR BEFORE JUNE 1, 2021