Office of the City Assessor
900 East Broad Street, Room 802
Richmond, Virginia 23219
Retail Property
Income and Expense Survey for Calendar Year of ______
Information provided is CONFIDENTIAL, in accordance with Virginia Law
Map Reference_______________________________ Property Address_________________________________
Form Preparer/Position________________________________________________________________________
Name
Position
Telephone Number_________________ Email Address _________________________________ Date________
The preparer above declares under penalties provided by law, this return (including any accompanying schedules and statements) has been examined and is
believed to be a 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 Description Information
(Please check applicable category and complete the related questions.)
_____________________________________________________________________________________________________________________________________
Property is totally owner-occupied Occupied Area ______________ Sq.Ft.
_____________________________________________________________________________________________________________________________________
Property is owner-occupied with Tenants Total Building Area ______________ Sq.Ft.
Owner-occupied Area ______________ Sq.Ft.
Tenant-occupied Area ______________ Sq.Ft.
_____________________________________________________________________________________________________________________________________
Property is fully leased Gross Leaseable Area (GLA) ______________ Sq.Ft.
Gross Building Area ______________ Sq.Ft.
_____________________________________________________________________________________________________________________________________
Property is: Vacant Total Building Area _____________ Sq.Ft.
Available for Sale Asking/List Price $____________
Available for Rent Asking Rent $____________
Holding for Future Use Please describe:
_________________________________________
_____________________________________________________________________________________________________________________________________
# Units/Unit sizes _____ 0-500sf _____ 500-1,500sf _____ 1,500-3,000sf
_____ 3,000-5,000sf _____ 5,000-10,000sf _____ 10,000-20,000sf
_____ 20,000-50,000sf _____ >50,000sf
_____________________________________________________________________________________________________________________________________
Parking Available: ______________ (number of spaces)
_____________________________________________________________________________________________________________________________________
Other Leased space: Cell Tower Date of Lease _______ Lease Amount $________ per/year
Company Name:__________________________________
Annual Income
Base Rental Income – Minimum $_________________
Additional Rental Income – overages $_________________
Parking Rental Income $_________________
Total Rent $_________________
Other Income (Reimbursements from Tenants)
Common Area Charges $_________________
Property Tax Reimbursement $_________________
Insurance Reimbursement $_________________
Utility Charge Reimbursement $_________________
Total Operating Receipts $__________________
Total Annual Income $__________________
Vacancy & Collection Loss ________________SF
(Year End)
Annual Operating Expenses
CAM* Paid By Paid By
Expense Landlord Tenants
Fixed Expenses
Real Estate Taxes $_______________
Insurance $_______________
Variable Expenses
Repair & Maintenance $_______________
Parking Lot Maintenance $_______________
Parking Rental Expense $_______________
Utilities $_______________
Trash Removal $_______________
Security $_______________
Advertising/Promotional $_______________
Administrative Expenses $_______________
Professional Services $_______________
Management Fees $_______________
Leasing Agent Fees $_______________
Other:_________________ $_______________
Other:_________________ $____________ ___
Total Operating Expenses $___________________
Net Operating Income $___________________
Please include your Income Summary, rent roll or use the one enclosed as a guide and typical lease. Attach comments
and/or other information on a separate page, ie. IRS Schedule E Supplemental Income and Loss form, capital expenses,
etc…
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OFFICE TENANT RENT ROLL SUMMARY
Address Tenant Name Net
Rentable Area
Annual
Rent
Lease Term Tenant Expenses
Tax, Insurance Charges, etc.
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Extra Forms are available on our Website at: www.richmondgov.com/Assessor/forms.aspx. Please save and email this completed survey to asktheassessor@richmondgov.com
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