RENTAL QUESTIONNAIRE                                                           TAX OFFICE USE ONLY

INCOME TAX DIVISION                                                            Date Issued
1 Cascade Plaza - 11th Floor                                                   Agent/Auditor
Akron, OH 44308 -1100
(330) 375-2290 Fax (330) 375-2112                                               Account No

  The following information is necessary for our records.  PLEASE COMPLETE AND RETURN THIS QUESTIONNAIRE WITHIN TEN (10) DAYS.

                                                                               Note: If you manage or supervise
                                                                               rental properties please complete
                                                                               the name and address lines below,
                                                                               which identifies the owner(s) of the
                                                                               property. Owners need to complete
                                                                               the entire questionnaire.

OWNER'S NAME                                                                   SOC SEC #
SPOUSE'S NAME                                                                  SOC SEC #
OWNER'S ADDRESS

DAYTIME PHONE                           BEST TIME TO CALL

BUSINESS NAME                                                                  FED ID #

BUSINESS ADDRESS

If you have filed a City of Akron Income Tax Return before, what name and account number did you use?
NAME USED                                                                      ACCOUNT NUMBER

If you are an Akron resident, list below all of the rental properties you own. If you are not an Akron resident, list only those
properties which are located in the City of Akron.

  Street Address                                        Date Acquired          Number of Units Gross Monthly Rents

1)
2)
3)
4)
5)
6)
7)

List any additional properties on the back of this form.

How many people do you employ in Akron?                 ( Include building managers, custodial, maintenance, secretarial, etc.)

Under penalties of perjury, I certify that all information and statements herein (both front and back) are true and correct.

Print Name

Signature                                                                      DATE

                                                                                                        3/97