Form Tc214 - Income And Expense Schedule For Department Stores, Theaters, And Parking Sites - 2016 Page 2

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3. LAND OR BUILDING LEASE INFORMATION AS OF JANUARY 5, 2016
Does the applicant or a related person pay rent pursuant to an arms-length lease of the property? _____ . If yes, complete this part.
LESSOR
IF NOT OWNER OF RECORD, DESCRIBE RELATION TO PROPERTY
LESSEE
IF NOT APPLICANT, DESCRIBE RELATION TO APPLICANT
Term of lease: from _______/_______ to _______/_______
Annual rent $ ________________________________
Start date of annual rent stated: ______/______.
End date of annual rent stated ______/______.
End date of lease option: ______/______.
Does lessor receive any sums in addition to annual rent stated? ______. If yes, state percentage rent: __________% of adjusted annual sales over
$ _______________.
Does lessor pay any of the real estate taxes? ______. If yes, specify: __________ % of taxes over $_______________ (year _____) up to maximum of
$ _______________.
Does lessor provide utilities or services? ______. If yes, specify :____________________________________________________________________
Has lessee improved the property? ______. If yes, specify improvements: _____________________________________________________________
Is the lease a ground lease?______.
BOROUGH
BLOCK
LOT
4. INCOME
YEAR 1
YEAR 2
YEAR 3
REPORTING PERIOD - Full years only
Year ending _____/_____/_____
Year ending _____/_____/_____
Year ending _____/_____/_____
GROSS SALES
Merchandise
Food and beverage
Parking
Automotive fuel
Admissions
Other sales
TOTAL GROSS SALES
Returns and refunds
Other adjustments:
ADJUSTED SALES
RENTAL INCOME
Leased departments
Other rentals
OTHER INCOME
TOTAL INCOME
5. EXPENSES
RENTAL EXPENSES
Fixed or minimum rent
Percentage rent
Real estate taxes paid by lessee
Common area maintenance
Other rental expense
TOTAL RENTAL EXPENSES
OTHER EXPENSES:
TOTAL EXPENSES
Page _____
TC214

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