Office of the City Assessor
900 East Broad Street, Room 802
Richmond, Virginia 23219
Hotel and Motel Property
Income and Expense Survey for Calendar Year of _______
Information provided is CONFIDENTIAL, in accordance with Virginia Law
Property Name_______________________________ Property Address_________________________________
(If applicable)
Form Preparer/Position________________________________________________________________________
Name Position
Telephone Number__________________ Email Address _______________________________ Date_________
Map Reference __________________________________
Signature and Verification
The signature above declares under penalties provided by law, this return (including any accompanying schedules and statements) has been examined and is believed to
be true, correct and complete return. If the return is prepared by any person other than the owner, his / her declaration is based on all the information relating to the
matters required to be reported in the return of which he / she has knowledge.
General Data
Business Name: ________________________ Total Number of Room Nights Available last year ______
Number of Available Rooms_________________ Total Number of Room Nights Sold last year _______
Limited Service Full Service Extended Stay Suite Motel
Room Configuration (number of rooms in each category
) / Rates
# Units Rent/day/unit Rent/week/unit
Annual Occupancy _________________
Annual Average Daily Rate (ADR) $_________________
Segmentation of Annual Occupancy
Transient Corporate Group Other
Percentage of
Annual Occupancy
ADR for Segment
(Hotel and Motel Cont’d.)
Annual Department Revenue
Rooms $_________
Conference Facilities $___________________
Food and Beverage $___________________
Parking $___________________
Telephone $___________________
Minor Operated Departments $___________________
Miscellaneous Rentals and Other Income $___________________
Total Annual Revenue $___________________
Annual Costs and Expenses
Rooms $___________________
Food and Beverage $___________________
Telephone $___________________
Minor Operated Departments $___________________
Leased Equipment $___________________
Administrative, Legal, Accounting $___________________
Marketing $___________________
HVAC $___________________
Property Operation and Maintenance $___________________
Franchise Fee $___________________
Parking $___________________
Other:_______________ $___________________
Total Operating Expenses $___________________
Management Fees $___________________
Fixed Operating Expenses
Real Estate Taxes $___________________
Property Insurance $___________________
Reserve for Capital Replacement $___________________
Other:______________ $___________________
Total Fixed Expenses $___________________
e value of furniture, fixture and equipment; business value $_________________
Comments and/or other information may be attached on a separate page, ie. IRS Schedule E Supplemental Income and Loss
form, capital expenses, etc…
Extra Forms are available on our Website at: Please save and email this completed survey to
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