Form Fp-42b - Hotel/motel Income And Expense Report - 2003
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5HOTEL/MOTEL INCOME & EXPENSE REPORT
TAX YEAR:
2003
DUE DATE:
APRIL 1, 2002
Report information from the period January 1, 2001 through December 31, 2001.
Government of the
District of Columbia
The Income and Expense information must
Office of the Chief Financial Officer
be reported on this form. Substitute forms are
Office of Tax and Revenue
not permitted. Supporting documentation is
acceptable. In order to assist you in complet-
941 North Capitol Street, N.E., Suite 400
ing this form, detailed instructions are in-
Washington, DC 20002
cluded with this report. Please be sure to re-
port expenses only once; double reporting is
Full Name
prohibited. If you have any questions or need
assistance, please contact our Assessment
c/o
Program Coordinator, Mr. Anthony Daniels,
at (202)442-6794. Complete this report in ac-
Mailing Address
cordance with accounting methodologies
used for Federal Income Tax reporting. Sub-
mission of audited statements is not required.
City / State / Zip
As per the D.C. Code § 47-821, this informa-
tion shall be kept in strict confidence. Failure
to submit the information requested by the
above due date is a violation of D.C. Real
Property Tax Law and will result in a penalty
Square
Suffix
Lot
Use Code
Neighborhood
of 10% of the real property tax amount due
for the following tax year.
Premise Address
A. Accounting Methodology
1. Method used to prepare this statement
Accrual
Cash
Uncertain
(This should reflect your accounting books; check one)
2. Indicate the periodic cycle used.
13-period
360-day year
Other
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 #
Print or Type Name
Signature
(original only, no stamped or copied signature)
This form must be signed and dated to receive credit for filing. Unsigned or substantially
incomplete submissions will be subject to all applicable penalties.
FP-421B REV 02/2002
— CONFIDENTIAL —
Page 1 of 7
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