Form Tc 214 - Income And Expense Shedule For Stores, Theaters And Service Sites Page 2

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BOR OUGH

BLOCK

LOT

4. INCOME

YEAR 1

YEAR 2

YEAR 3

____/____/____

year ending

REPORTING PERIOD - Full years only

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 EXPENSE

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

NSTRUC TIONS FOR TC 214: Use this form to re port in come de rived from op era tion of a re tail store, gaso line fill ing sta tion, pub lic park -

ing ga rage or lot or thea ter or other serv ice es tab lish ments. Sub mis sion of this form is re quired for gas sta tions, pub lic park ing lots and ga rages

and thea ters. It is also re quired for re tail stores with more than 10,000 gross square feet of re tail floor area, and all stores in leased prem ises when

part of the rent is based on a per cent age of sales. At tach the com pleted sched ule to an Ap pli ca tion for Cor rec tion. Re port sales and rental in -

come for the past three cal en dar or fis cal years. Re port ing of ex penses other than rent is op tional. If there are leased de part ments or con ces sions,

re port the rent re ceived on this form. If there is other rental in come, also at tach form TC 201 .

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TC 214