Fillable Form 2020: ANNUAL INCOME AND EXPENSE REPORT CITY (City of Waterbury, CT)

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Form 2020: ANNUAL INCOME AND EXPENSE REPORT CITY (City of Waterbury, CT)

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CITY OF WATERBURY
2020
ANNUAL INCOME AND
EXPENSE REPORT
RETURN TO:
ASSESSOR'S OFFICE
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
reported.
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
Owner Name
Mailing Address
Property Location
(if different from front)
Map/Blk/Lot __________________________________________________________________
City/State/Zip
1
Primary Property Use (Check One)
Apartment Office Retail Mixed Use Shopping Ctr. Industrial 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 Number Of Units 9 # of Heating Systems _____________________________
9 Apartment Rentals (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)
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
TOTAL POTENTIAL INCOME
30 Legal and Accounting
(Add Line 9 Through Line 17)
31 Elevator Maintenance
19 Loss Due to Vacancy and Credit 32 Tenant Improvements
20 EFFECTIVE ANNUAL INCOME 33 General Repairs
(Line 18 Minus Line 19)
34 Other (Specify)
35 Other (Specify)
36 Other (Specify)
37 Security
38
TOTAL EXPENSES (Add Lines 21 Through 37)
39
NET OPERATING INCOME (Line 20 Minus Line 38)
40 Capital Expenses
41 Real Estate Taxes
42 Mortgage Payment (Principle and Interest)
2020 ANNUAL INCOME AND EXPENSE REPORT SUMMARY
INCOME
EXPENSES
SCHEDULE A - 2020 APARTMENT RENT SCHEDULE Complete this Section for Apartment Rental activity only.
UNIT SIZE
RENTED ROOMS BATHS SQ. FT. PER UNIT TOTAL
EFFICIENCY
Heat Furnished Unit
Electricity Security
Other Utilities Pool
Air Conditioning Tennis Courts
Stove/Refrigerator Parking
Dishwasher
Garbage Disposal
Other Specify
SCHEDULE B - 2020 LESSEE SCHEDULE
Complete this Section for all other rental activities except apartment rental.
LOCATION
OF SPACE
START END SQ.FT BASE ESC/CAM TOTAL PER NO. OF OWNER COST
OVERAGE SQ. FT. SPACES
TOTALS
UNIT TYPE
(Please Check All That Apply)
COPY AND ATTACH IF ADDITIONAL PAGES ARE NEEDED
ROOM COUNT
MONTHLY RENT
TYPICAL
LEASE TERM
BUILDING FEATURES INCLUDED IN
RENT
TOTAL
NO. OF UNITS
INTERIOR FINISH
TENANT
RENT
PARKING
ANNUAL
OTHER RENTABLE UNITS
SUBTOTAL
OWNER/MANAGER/JANITOR OCCUPIED
4
BEDROOM
BEDROOM
1
2
BEDROOM
3
BEDROOM
GARAGE/PARKING
OTHER INCOME (SPECIFY)
TOTALS
TOTAL
LEASE TERM
ANNUAL RENT
NAME OF TENANT
VERIFICATION OF PURCHASE PRICE
PURCHASE PRICE $ DOWN PAYMENT $
DATE OF PURCHASE
% OCCUPANCY AT TIME OF SALE
DATE OF LAST APPRAISAL APPRAISAL FIRM APPRAISED VALUE
FIXED VARIABLE
FIRST MORTGAGE $ INTEREST RATE % PAYMENT SCHEDULE TERM YEARS
SECOND MORTGAGE $ INTEREST RATE % PAYMENT SCHEDULE TERM YEARS
OTHER $ INTEREST RATE % PAYMENT SCHEDULE TERM YEARS
CHATTEL MORTGAGE $ INTEREST RATE % PAYMENT SCHEDULE TERM YEARS
DID THE PURCHASE PRICE INCLUDE A PAYMENT FOR: FURNITURE? $ EQUIPMENT? OTHER (Specify) $
HAS THE PROPERTY BEEN LISTED FOR SALE SINCE YOUR PURCHASE? (Check One) YES NO
IF YES, LIST THE ASKING PRICE $ DATE LISTED
Remarks - Please explain any special circumstances or reasons concerning your purchase (I.e., vacancy, conditions of sale, etc.)
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 DATE
TITLE E-MAIL_____________________________________
BROKER
NAME (Print)
TELEPHONE
(Check One)
(Value)
(Value)
(Value)
RETURN TO THE ASSESSOR ON OR BEFORE JUNE 1, 2021
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Form 2020: ANNUAL INCOME AND EXPENSE REPORT CITY (City of Waterbury, CT)

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Completed 21 March 2021

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