Free Cemetery - Maryland

CEMETERY INCOME AND EXPENSE QUESTIONNAIRE
INCOME QUESTIONNAIRE FOR 36 MONTHS:
NAME AND LOCATION OF PROPERTY

FROM ____2006_____ TO ____2008_____
OWNER AND ADDRESS OF RECORD

TOTAL ACREAGE:

Developed - Sold Developed - Unsold Undeveloped AVERAGE NUMBER OF SITES PER ACRE
ANNUAL INCOME:
1. Sales _____sites @_________ 2. Sales _____crypts @_______ 3. Perpetual Care Fund Investments 4. Miscellaneous (List) 5. TOTAL INCOME EXPENSES: 1. Sales Commission ( sites & crypts) 2. Cost of site improvements 3. Cost of crypts 4. Perpetual Care Reserve 5. Contingencies/Maintenance (list) 6. Administration 7. Insurance 8. Miscellaneous Expense (list) 9. Real Estate Tax 10. Building Depreciation 11. TOTAL EXPENSES

____________ Acres ____________ Acres ____________ Acres ___________
2007
__________ __________ __________ __________ __________ __________ __________ __________ __________ __________ __________ __________ __________ __________ __________ __________

2008
$__________ $__________ $__________ $__________ $__________ $__________ $__________ $__________ $__________ $__________ $__________ $__________ $__________ $__________ $__________ $__________

2006
__________ __________ __________ __________ __________ __________ __________ __________ __________ __________ __________ __________ __________ __________ __________ __________

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-67 (Rev. 12/03rs)