Form Fp-421b Hotel/motel Income & Expense Report
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5HOTEL/MOTEL INCOME & EXPENSE REPORT
2006
April 01, 2005
TAX YEAR:
DUE DATE:
Report information from the period
January 01, 2004
through
December 31, 2004
.
I
E
Government of the District of Columbia
NCOME AND
XPENSE INFORMATION MUST
. S
BE REPORTED ON THIS FORM
UBSTITUTE
Office of the Chief Financial Officer
. S
FORMS ARE NOT PERMITTED
UPPORTING
Office of Tax and Revenue
. I
DOCUMENTATION IS ACCEPTABLE
N ORDER
941 North Capitol Street, N.E., Suite 400
,
TO ASSIST YOU IN COMPLETING THIS FORM
Washington, DC 20002
DETAILED
INSTRUCTIONS ARE INCLUDED
. P
WITH THIS REPORT
LEASE BE SURE TO
;
REPORT EXPENSES ONLY ONCE
DOUBLE
. I
REPORTING IS PROHIBITED
F YOU HAVE ANY
S
:
L
,
,
QUESTIONS
OR NEED ASSISTANCE
PLEASE
QUARE
SUFFIX
OT
USE CODE
NEIGHBORHOOD
A
P
CONTACT
OUR
SSESSMENT
ROGRAM
test
P
A
:
C
, A
D
,
202-
REMISE
DDRESS
OORDINATOR
NTHONY
ANIELS
AT
442-6794. C
OMPLETE
THIS
REPORT
IN
ACCORDANCE
WITH
ACCOUNTING
F
METHODOLOGIES
USED
FOR
EDERAL
. S
INCOME TAX REPORTING
UBMISSION OF
. A
AUDITED STATEMENTS IS NOT REQUIRED
S
D.C. C
§ 47-821,
PER
THE
ODE
THE
INFORMATION CONTAINED IN THIS REPORT
MAILING ADDRESS
.
SHALL BE KEPT IN STRICT CONFIDENCE
F
AILURE
TO
SUBMIT
THE
INFORMATION
REQUESTED BY THE ABOVE DUE DATE IS A
D.C. R
P
T
VIOLATION OF
EAL
ROPERTY
AX
L
10%
AW AND WILL RESULT IN A PENALTY OF
OF THE REAL PROPERTY TAX AMOUNT DUE
.
FOR THE FOLLOWING TAX YEAR
.
A
ACCOUNTING METHODOLOGY
1.
.
.)
METHOD USED TO PREPARE THIS STATEMENT
CHECK ONE ONLY
THIS SHOULD REFLECT YOUR ACCOUNTING BOOKS
Accrual
Cash
Uncertain
2.
INDICATE THE PERIODIC CYCLE USED
13-period
Other
360-Day
.
B
CERTIFICATION
,
I CERTIFY UNDER PENALTY OF LAW THAT THE INFORMATION PROVIDED IS TRUE
CORRECT AND COMPLETE TO THE BEST OF MY
.
,
.
.
KNOWLEDGE AND BELIEF
MAKING A FALSE STATEMENT AS TO MATERIAL FACTS IS PUNISHABLE BY CRIMINAL PENALTIES
D
C
CODE
§22-2514.
:
NAME OF MANAGEMENT COMPANY
/
:
TITLE
RELATIONSHIP
:
:
RESPONSIBLE CONTACT PERSON
PHONE
:
ADDRESS
:
’
#:
DATE
OWNER
S FEDERAL TAX ID
S
PRINT OR TYPE NAME
IGNATURE
(
,
)
ORIGINAL ONLY
NO STAMPED OR COPIED SIGNATURE
.
/
THIS FORM MUST BE SIGNED AND DATED TO RECEIVE CREDIT FOR FILING
UNSIGNED AND
OR SUBSTANTIALLY INCOMPLETE SUBMISSIONS WILL
.
BE SUBJECT TO ALL APPLICABLE PENALTIES
FP-421B REV 10/2004
***CONFIDENTIAL***
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