Free Hotel/Motel - Maryland

HOTEL/MOTEL
INCOME QUESTIONNAIRE FOR 36 MONTHS:
NAME AND LOCATION OF PROPERTY

FROM ____2006______ TO _____2008_____
OWNER AND ADDRESS OF RECORD

Total Number of Rentable Rooms: ________

Number of Parking Spaces: ___________ 2008 2007
___________ ___________ ___________ ___________ ___________ ___________ ___________ ___________ ___________ ___________ ___________ ___________ ___________ ___________ ___________ ___________ ___________ ___________ ___________ ___________ ___________ ___________ ___________ ___________ ___________ ___________ ___________ ___________ ___________ ___________ ___________

2006
___________ ___________ ___________ ___________ ___________ ___________ ___________ ___________ ___________ ___________ ___________ ___________ ___________ ___________ ___________ ___________ ___________ ___________ ___________ ___________ ___________ ___________ ___________ ___________ ___________ ___________ ___________ ___________ ___________ ___________ ___________

Average Annual Rate/Room/Day $___________ Average Number of Rooms Occupied/Day $___________ Percentage of Occupancy for Year $___________ ANNUAL INCOME: 1. Room Rentals $___________ 2. Food $___________ 3. Beverages $___________ 4. Telephone Service $___________ 5. Other Income (Attach List) $___________ 6. Retail Tenant (Attach List) $___________ 7. TOTAL (Lines 1 - 6) $___________ EXPENSES: Cost of Goods Sold, Departmental Wages and Expenses 8. Rooms $___________ 9. Food and Beverages $___________ 10. Telephone Services $___________ 11. Other Costs (Attach Itemized List) $___________ 12. Total Departmental Expenses (Lines 8 - 11) $___________ 13. Gross Operating Income (Line 7 minus Line 12) $___________

UNALLOCATED EXPENSES:
14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. 26. 27. 28. Administrative & General Expenses Marketing Energy Property Operations & Maintenance Fire Insurance & Extend. Coverage Management Fee Total Unallocated Expenses (Lines 14 - 19) NOI (Line 13 minus Line 20) Real Estate Taxes Mortgage Payment Building Depreciation Capital Expenditure (List) Furn., Fixtures & Equip. Total Values Return on Furn., Fixtures & Equip. Return of Furn., Fixtures & Equip $___________ $___________ $___________ $___________ $___________ $___________ $___________ $___________ $___________ $___________ $___________ $___________ $___________ $___________ $___________

MORTGAGE/SALES INFORMATION:
1. Is there a current mortgage on this property? 2. If Yes, please provide the following data: ________________________________ Name of Mortgagee ___________________ Term of Mortgage 3. Please provide: Yes _________ No _________ ___________________ Mortgage Amount ___________________ Date 1st Payment ________________ Interest Rate ________________ Monthly Payment

Date Purchased______________

Consideration______________

I declare, under the penalties of perjury, that the contents of this form and all the accompanying schedules and statements have been examined by me and are true, correct, and complete to the best of my knowledge, information, and belief. __________________________________ Signature __________________________________ Print/Type Name of Signer ________________________ Title of Signer _______________ Phone Number ______________ Date RP-61 (Rev. 12/03 rs)