Form Rpie-214-02 - Income And Expense Schedule For Department Stores, Theaters, Parking Or Other Business Income Page 2

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BOROUGH
BLOCK
LOT
4. INCOME
AMOUNT ($) YEAR 1
AMOUNT ($) YEAR 2
AMOUNT ($) 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 (itemize)
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
INSTRUCTIONS FOR FORM RPIE-214: Use this form if you are reporting income derived from operation of a
store, gas station, public parking garage or lot, or theater. Report sales and rental income for the filer’s most
recently completed calendar or fiscal year in “Year 3” column. Reporting for the prior two years is optional.
Reporting of expenses other than rent is optional. If there are leased departments or concessions, report the
rent received on this form. If there is other rental income, also attach Form RPIE-201.
RPIE-214-02

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