Form Rpie-Ez - Real Property Income And Expense Form

Form Rpie-Ez - Real Property Income And Expense Form - 2008 Page 2

RPIE-EZ-2008 - Real Property Income & Expense EZ Form

Page 2

SECTION D - INCOME AND EXPENSE INFORMATION

1. Provide information for a full year. If the information is for less than a full year, list the number of months:______________________

2. Gross Income:

$____________________________ Include property income from all sources including the sale of utilities, rent

from signage (e.g., bill boards) or cell towers or other equipment on your property.

3. Gross Expenses: $____________________________ DO NOT include real estate tax, mortgage or loan expenses.

SECTION E - RPIE CERTIFICATION

I hereby certify that I am the owner or other person responsible for the payment of taxes, or the per-

son authorized by the owner or taxpayer to make this statement. I certify that all information con-

tained in this statement is true and correct to the best of my knowledge and belief. I understand that

the willful making of any false statement of material fact herein will subject me to the provisions of

law relevant to the making and filing of false instruments and will render this statement null and void.

____________________________________________

________________________________________

_______________________

Signature

Name (print)

Date

PRIVACY ACT NOTIFICATION

The Federal Privacy Act of 1974, as amended, requires agencies requesting Social Security

Numbers to inform individuals from whom they seek this information as to whether compli-

ance is voluntary or mandatory, why the request is being made and how the information will

be used. The disclosure of Social Security Numbers by owners is mandated by Section 11-

102.1 of the Administrative Code of the City of New York. Disclosure by lessees is voluntary.

Disclosure is requested to facilitate the processing of real property income and expense

data. Such data, including any Social Security Numbers so disclosed, are used for tax

administration purposes. The data, including any Social Security Numbers, may be further

disclosed to other departments or agencies, or to persons employed by such departments

or agencies, only for such purposes, or as otherwise provided by law or judicial order.

Form Rpie-Ez - Real Property Income And Expense Form - 2008 Page 2