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RPIE   2020-

                    WORKSHEET 

                  FOR GAS STATION, 

                    CAR WASH AND 

                  OIL CHANGE FACILITIES 

                  Real Property 

                  Income and Expense 

                  Worksheet and Instructions 

                  for Gas Station, Car Wash and 

                  Oil Change Facilities 

                  This is NOT the RPIE form.  

                  This document is designed to as-

                  sist you in completing the RPIE 
 
                  form for gas station, car wash 
 
                  and oil change facilities. 
 
 RPIE-WORKSHEET 

                                        nyc.gov/rpie
 Revised 2.10.2021

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2020 REAL PROPERTY INCOME AND EXPENSE
WORKSHEET AND INSTRUCTIONS FOR GAS STATION,
CAR WASH AND OIL CHANGE FACILITIES
FILING DEADLINE: JUNE 1, 2021

This is NOT the Real Property Income and Expense (RPIE) form. You MUST file all
RPIE forms electronically. This form is to be used for worksheet purposes only.

GENERAL INFORMATION

Owners of income-producing properties with an Actual Assessed Value of more than $40,000 as stated on the
2021-2022 Tentative Assessment Roll are required to file Real Property Income and Expense statements (“RPIE”)
or a Claim of Exclusion annually with the Department of Finance (DOF). Finance uses this and/or information from
similar properties to estimate the market value of property for tax purposes.

Even if your income-producing property has an Actual Assessed Value of less than $40,000, you may still want to
provide information about your property electronically to assist us in providing a more accurate estimate of the mar-
ket value.

Please note that this worksheet and instructions are for gas station, car wash, and oil change facilities. These in-
structions do not apply to the following specialty properties types: hotels, adult care/nursing home facilities, the-
aters or concert halls. These property types are covered in their own instructions that you can download from
nyc.gov/rpie.

RPIE EXCLUSIONS
How do you file a Claim of Exclusion?
To file a Claim of Exclusion, you must complete Section D of the RPIE-2020 form. Owners of real property
who are not required to file income and expense information must submit a Claim of Exclusion each year.

Please note: If you own the property but have no knowledge of the income and expenses for the entire cal-
endar or fiscal year, you must file a Claim of Exclusion.

Who does not have to file an RPIE or Claim of Exclusion? Owners with:
● Properties that have an Actual Assessed Value of $40,000 or less
● Residential properties containing 10 or fewer dwelling units
● Tax Class 1 or Tax Class 2 properties with six or fewer dwelling units and no more than one commercial unit
● Special franchise properties

IMPORTANT FILING INFORMATION

● Online Filing Requirement: All filers are legally required to file electronically unless the Department of Fi-
nance grants a waiver. Filers who wish to request a waiver from the electronic filing should call 311 for an
application, or download the application from nyc.gov/rpie. The deadline for electronic waiver requests is
May 3, 2021.

● Deadline -- The submission deadline for all RPIE filings is June 1, 2021.

CUSTOMER ASSISTANCE

Please call 311 or email the Department of Finance at rpie@finance.nyc.gov

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Instructions for Worksheet RPIE-2020 - Gas station, car wash and oil change facilities Page 2

PART I: OWNER AND PROPERTY INFORMATION

Please check your mailing address for accuracy. Owners are responsible for maintaining a current mail-
ing address with Department of Finance at all times. You can see the mailing address on file by look-
ing at your latest Notice of Property Value or Property Tax bill. Changes to your address can be made
online at http://nyc.gov/changemailingaddress or by calling 311.

SECTION A – OWNER/FILER INFORMATION

1a. Enter name(s) of up to two owners of the property.

b./c. Enter each listed owner’s Employer Identification Number (EIN) or Social Security Number (SSN).

The Federal Privacy Act of 1974, as amended, requires Finance to inform you as to whether
compliance with the request is voluntary or mandatory, the legal authority to request the infor-
mation, and how the information will be used. Owners must provide their Social Security Num-
ber on this form under the authority of section 11-102.1 of the Administrative Code of the City of
New York. Social Security Numbers are required to facilitate the processing of real property in-
come and expense data for tax administration purposes. The Social Security Numbers may be
further disclosed to other departments or agencies, or to persons employed by such departments
or agencies, only for tax administration purposes, or as otherwise provided by law or judicial
order.

2a. Enter the name of the person filing the RPIE. The filer may be an owner, owner representative,
lessee or lessee representative who is authorized to provide this information and has knowledge
of such information.

b./c. Enter the filer’s Employer Identification Number or Social Security Number.

d. Use the dropdown box to select the filer’s relationship to the property.

SECTION B - CONTACT INFORMATION
Provide contact information for the person who can respond to questions about this filing and receive
the confirmation email once the RPIE is submitted. Additional email addresses for the confirmation
email can be entered on the Certification page.

SECTION C – NOT APPLICABLE FOR GAS STATION, CAR WASH AND OIL CHANGE FACILITIES

SECTION D - RPIE EXCLUSIONS
If you are identified as a required RPIE-2020 filer, you will need to complete an income and expense form
or complete a claim of exclusion in Section D. If your property is income-producing and eligible to claim
an RPIE exclusion, please identify one of the exclusions listed in the section below.

Exclusions include:
a. Properties with actual AV (Assessed Value) as shown on the Tentative Assessment Roll
2021-2022 of $40,000 or less.

b. Properties that are both exclusively residential and have 10 or fewer apartments, including both
vacant and occupied units.

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Instructions for Worksheet RPIE-2020 - Gas station, car wash and oil change facilities Page 3

c. Properties that have both of the following: six or fewer residential units and no more than one
commercial unit. Your property must be in Tax Class 1 or Tax Class 2, and the unit count must
include all units whether vacant or occupied. For example, if your property has five residential and
two commercial units, you must file an RPIE because you have two commercial units.

d. Residential cooperative apartment buildings with no more than 2,500 square feet of commercial
space (not including garage space). To claim this exclusion you must still complete the RPIE-2020
(Parts I and IV). An RPIE is required for unsold sponsor-owned units if 10% or more of the units
remain unsold.

e. Individual residential units in a condominium building/development. For a residential condo-
minium that has commercial space, professional space, and/or has 10% or more unsold spon-
sor-owned units, an RPIE must be filed for the commercial space, professional space or the
unsold sponsor-owned units. An RPIE must also be filed for residential units that are rentals and
not intended to be individually owned.

f. If the property is rented exclusively to a person or entity related to the owner:
● Business entities under common control.
● Fiduciaries and the beneficiaries for whom they act.
● Spouse, parents, children, siblings and parents in-law.
● Owner-controlled business entities.

g. The entire property is owner-occupied. This exclusion does not apply to owners of department
stores of 10,000 square feet or more, hotels or motels (whether occupied in part or in their en-
tirety), parking garages or lots, power plants and other utility-property, adult care/nursing home
facilities, gas stations, car washes, oil change facilities, self-storage, theatres or concert halls.

h. The property is owned by a not-for-profit organization, government entity or is otherwise fully ex-
empt from property taxes and is not rented to any commercial, non-exempt tenants. If the prop-
erty is rented to a commercial, non-exempt tenant, the filing requirement may be satisfied by the
tenant or lessee filing an RPIE on behalf of the property.

i. The property is vacant or uninhabitable and has no existing leases. If there are any existing
leases, the owner must file the RPIE.

j. “Vacant, non-income-producing land” applies to empty lots only.

k. The owner has not operated the property and does not know the income and expenses for the
entire calendar or fiscal year of the reporting period.

If you claimed exclusion(s), but still want to file income and expense information with the Department
of Finance, select “OK” at the pop-up message prompting you for a response on voluntary filing.

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Instructions for Worksheet RPIE-2020 - Gas station, car wash and oil change facilities Page 4

PART II: INCOME AND EXPENSE STATEMENT FOR GAS STATION, CAR WASH AND OIL

CHANGE FACILITIES ONLY

SECTION E - VACANCY INFORMATION
1. Percentage of space that was vacant as of the taxable status date (January 5, 2021):
● Select the checkbox and provide the percentage of vacant space as of January 5th, 2021 for
one or more of the following uses:
● Gas Station
● Kiosk
● Car Wash
● Oil Change Facility
● Convenience Store
● Repair Shop

SECTION F – NOT APPLICABLE FOR GAS STATION, CAR WASH AND OIL CHANGE FACILITIES

SECTION G – THIS SECTION IS NO LONGER USED

SECTION H - LEASE AND OCCUPANCY INFORMATION
1) Indicate if the tenant leases the entire property. ❑ Yes ❑ No
2) Indicate if the tenant pays utility expenses. ❑ Yes ❑ No
3) Indicate if the tenant pays maintenance and repair expenses. ❑ Yes ❑ No
4) Indicate if the tenant pays property tax for the space occupied. ❑ Yes ❑ No
5) Enter the amount of Annual Rent paid to the Property Owner. ______________
6) Indicate if the net lessee or owner related party subleasing is
any of the property.
a) If yes, list the number Square Footage. ______________
b) If yes, list the Use of Space. ______________
c) If yes, enter the Annual Rent. ______________
7) Indicate if you are filing as ground lessor.
a) If yes, enter the Ground Lease Amount that you are receiving. ______________
A ground lease is a lease in which the right of use and
occupancy of land is granted.

SECTION I - REPORTING PERIOD
Please Note: Data for 2020 is required for submission. Data for both 2019 and 2018 is not mandatory.
1-2. Indicate whether the RPIE filing is for a calendar, fiscal or partial year, and enter the start and end
dates of the reporting period.

3. Provide the name of the gas station, car wash or oil change facility.

SECTION J – NOT APPLICABLE FOR GAS STATION, CAR WASH AND OIL CHANGE FACILITIES

SECTION K - INCOME
Gas Station / Car Wash / Oil Change Facility Real Estate Rental Income
1. Rent: Amount received from renting the gas station / car wash / oil change facility as a whole
(does not include business income).

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Instructions for Worksheet RPIE-2020 - Gas station, car wash and oil change facilities Page 5

Business Income
1. Merchandise: Amount received from retail sales of items such as cigarettes.

2. Food and Beverage: Amount received from sales of food and beverage items.

3. Automotive Fuel: Amount received from sales of automotive fuel.

4. Other Sales (Car Wash, Repair Shop, Etc.): Amount received from ancillary or miscellaneous in-
come sources such as car wash and repair shop fees.

5. Total Business Income: Calculated as the sum of lines 1 through 4 in the “Business Income” section.

Other Income
1. Signage/Billboard: Amount received from renting any signage or billboard space anywhere on the property.

2. Cell Towers: Amount received for placing a cell tower or antenna anywhere on the property.

3. Other (describe): Any income generated by the property that has not been previously specified.
Do not include interest on bank accounts or tenants’ deposits. You must itemize the sources of
this income.

Total Income: Calculated as the sum of all income items listed above in the “Gas Station / Car Wash /
Oil Change Facility Real Estate Rental Income,” “Business Income” and “Other Income” sections.

Cost of Goods Sold
Definition of “Cost of Goods Sold”: Cost of Goods Sold (COGS) represents the direct costs attribut-
able to the production of the goods sold by a company. This includes the cost of the materials used to
create the goods as well as the direct labor costs used to produce the goods.

1. Merchandise: COGS related to the sale of retail items such as cigarettes.

2. Food and Beverage: COGS related to the sale of food and beverage items.

3. Automotive Fuel: COGS related to the sale of automotive fuel.

4. Other Sales (car wash, repair shop, etc.): COGS related to ancillary or miscellaneous income
sources such as car wash and repair shop fees.

5. Total Cost of Goods Sold: Calculated as the sum of lines 1 through 4 in the ”Cost of Goods Sold”
section.

6. Gross Profit: Calculated by subtracting Total Cost of Goods Sold from Total Business Income.

SECTION L – BUSINESS EXPENSES
1. Labor Costs: Annual amount of wages, payroll taxes, workers’ compensation, health insurance,
and other employee benefits.

2. Insurance: Annual charges for fire, liability, theft coverage and other insurance premiums paid to
protect the real property. Pro-rate multi-year premiums to calculate an average annual expense.

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Instructions for Worksheet RPIE-2020 - Gas station, car wash and oil change facilities Page 6

3. Royalty Fees: Ongoing monthly or annual payments to the franchisor to cover administrative and
marketing costs, usually based on a percentage of gross or net sales.

4. Franchise Fees: An up-front charge that the operator pays to use the licensed concept.

5. Credit Card Fees: All merchant fees charged by credit card companies for the acceptance of
credit cards as a form of payment.

6. Supplies: All purchases of items not for resale that are used in the management and operation
of the business. Cleaning products and office supplies fall into the supply category.

7. Advertising: All costs associated with advertising the business, including billboards, radio spots,
print, internet and social media.

8. Maintenance and Repairs: Amounts paid or incurred for contracts with maintenance companies.
Include any amounts that were paid for routine repair services and for material or parts used for
repairs. Do not include reserves for replacements.

9. Energy: Costs of electricity, fuel oil, gas or steam, water and sewer.

10. Management and Administration: Salaries/wages/payroll taxes and employee benefits, legal and
accounting fees, office supplies, etc.

11. Motor Fuel Drive-offs: Cost incurred when motorists fill up then leave without paying for the fuel.

12. Cash Short: Cost incurred when less money came into the cash register than should have been
received.

13. Other (describe): The Other field should be reserved for expenses that can not be otherwise cat-
egorized, such as petty cash and sundry. Filers will be prevented from entering expense items
that are ineligible. Please review the charts on pages 9 through 12 for a list of frequently
miscategorized expenses and corresponding expense categories.

14. Total Business Expenses: Calculated as the sum of lines 1 through 13 in “Section L – Business
Expenses”.

Calculation of Adjusted EBIDTA
Definition of EBIDTA: EBIDTA stands for Earnings Before Interest, Taxes, Depreciation and Amortization.
1. Gross Profit: Calculated by subtracting Total Cost of Goods Sold from Total Business Income.

2. Less Total Business Expenses: Calculated as the sum of lines 1 through 13 in “Section L – Busi-
ness Expenses.”

3. Adjusted EBIDTA: Calculated by subtracting Total Business Expenses from Gross Profit.

SECTION L2- RECAPITULATION, FURNITURE, FIXTURES AND EQUIPMENT
Furniture, Fixtures and Equipment (FF & E): Movable furniture, fixtures or other equipment that have
no permanent connection to the structure of the building or utilities.

PART IV – RPIE CERTIFICATION

To successfully submit your RPIE filing you must certify the information by clicking “Sign and Submit.”
If you do not complete this step you will not be in compliance with the RPIE filing requirement.

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Instructions for Worksheet RPIE-2020 - Gas station, car wash and oil change facilities     Page 7

 MISCELLANEOUS EXPENSE CATEGORIES CHART

            Types of             Correct               Types of                         Correct 
        Expenses                 Category             Expenses                          Category

Advertising related to specific              A/C repairs or upkeep                      
property rentals                             Air conditioning repairs                   
Newspaper ads                                or upkeep                                  
NYC illuminated sign charge     Advertising  Alarm system maintenance                   
Promotional ads                              Appliance repairs                          
Television ads                               Asbestos maintenance                       
                                             Asphalt repair                             
Cleaning service contract       Cleaning     Boiler repairs                             
                                Contracts    Building repairs                           
                                             Burglar and fire alarm system              
Con Ed steam                                 maintenance                                
Gas for heating                 Fuel         Carpenters                                 
Oil                                          Chemicals for cleaning                     
                                             Cleaning Service                           
Boiler explosion premium                     Cleaning Supplies                          
Fire premium                                 Electrical system repairs                  
Liability premium               Insurance    Electricians                               
Rent fidelity bonds premium                  Elevator repairs                           
Theft premium                                Emergency repair service                   
                                             Equipment rental                           
Brushes                                      Exterior painting                         Repairs 
Decorating                                   Exterminator/Pest Control                 and 
Interior Painting               Interior     Gardening                                 Maintenance
Labor for interior decorating   Painting     Gas service 
Paint                           and          General maintenance 
Painting and Plastering         Decorating   and repairs 
Spackling                                    Glaziers 
Wallpaper                                    Graffiti removal 
                                             Hall maintenance 
Amortized leasing commissions                Hardware 
Brokers' fees                                HVAC 
Consultants' fees               Leasing      Insecticide 
Leasing agent's fees            Commissions  Intercom repairs 
Leasing contracts                            Iron work 
Prorated leasing commissions                 Janitorial Services 
                                             Janitorial Supplies 
City and State utility tax                   Landscaping 
Electricity                     Light        Lawn 
Gas for cooking stove           and          Lobby Maintenance 
NYC and NYS utility tax         Power        Locksmiths 
                                             Masonry 
                                             Outside labor 
                                             Parking lot repairs

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Instructions for Worksheet RPIE-2020 - Gas station, car wash and oil change facilities     Page 8

             Types            Correct                   Types of                        Correct 
        of Expenses           Category                  Expenses                        Category

Plastering                                  Escalation billing service                  
Plumbers                                    Eviction fees (except $1000                 
Plumbing repairs                            and under)                                  
Pointing ($500 or less)                     Food for watchdogs                          
Pollution repairs                           General office expense                      
Refrigeration repairs                       Inspections (boilers, elevator,             
Roof repairs                                fire, etc.)                                 
Safety devices                              Interim Multiple Dwelling filing            
Security                                    fee                                         
Sidewalk repairs             Repairs        Keys                                        
Smoke detectors              and            Legal Fees                                  
Snow removal                 Maintenance    Loft Board fees                             
Sprinkler system maintenance                Management agent fees                       
Stairwell maintenance                       Management fees                             
Supplies necessary for                      Marshall's fees                             
maintenance and repairs                     Maximum base rent filing fee               Management 
Swimming pool maintenance                   Membership fees                            and 
Tile repairs                                Messenger ($200 or less)                   Administration 
Waterproofing                               Meter reading service (water                
Welders                                     meters, electric meters, etc.)              
Window cleaning                             Office expense                              
Window guards                               Office Supplies                             
                                            Outside management                          
Accounting Fees                             Outside services (other than                
Administrative fees                         subcontracted labor)                        
ADT computer payroll service                Permits                                     
Association dues                            Post Office Box fee                         
Auditing                                    Postage                                     
BID fees                                    Professional Fees                           
Bookkeeping fees                            Protection                                  
Building registration fee                   Real Estate Publications and                
Carting                                     Journals                                    
Certified mail               Management     Realty Advisory Board fees                  
Collection fees              and            Rent collection fees                        
Computer processing          Administration Rent stabilization association fee          
Consultation fees                           Rubbish removal                             
Credit Card Fees                            Scavenger service 
Credit Check                                Security Guards 
Data processing costs                       Security Service 
DHCR Monitoring                             Service charges 
Directory service                           Service contracts 
Dispossess filing fees                      Settlement 
Dues                                        Small property owners 
Elevator service contract                   association 
Environmental protection                    Stationery

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Instructions for Worksheet RPIE-2020 - Gas station, car wash and oil change facilities Page 9

          Types of              Correct 
          Expenses              Category

Superintendent's telephone      
Tank registration               
Telecommunication               
Telephone                       
Tenant relations                
Trash/Garbage/Rubbish          Management 
removal                        and 
Uniforms                       Administration 
Uniforms (purchase and          
cleaning)                       
Vault tax                       
Water conditioning              
Water purification              
Water treatment service         
                                
Disability welfare              
Employee benefits               
Federal unemployment insurance  
Federal, State and City         
withholding tax                 
FICA social security tax        
Health insurance                
Hospitalization                 
Major medical                  Wages 
Management commissions         and 
New York State unemployment    Payroll 
insurance                       
Payroll Tax                     
Pension                         
Salaries (except directors &    
officers)                       
State unemployment insurance    
Union dues                      
Workmen's compensation          
 
Frontage 
                               Water and 
Sewer charges or taxes 
                               Sewer
Water charges or taxes

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Instructions for Worksheet RPIE-2020 - Gas station, car wash and oil change facilities                        Page 10

Below are Ineligible Miscellaneous Expenses and expenses that are Eligible to be included in the 
Expense portion of the RPIE.

                               Ineligible Miscellaneous Expenses

Air rights                     Engineer's fee                                          Personal insurance 
Alterations                    Equipment purchase                                      Pointing - over $500 
Amortization (except leasing)  Estimate expenses (except real  Projected expenses 
Appliances                     estate taxes)                                           Pro-rated expense of any kind 
Appraisal fee                  Financial charges or expenses                           (except leasing and insurance) 
Architects fees                Fines                                                   Public phone charge 
Automobile expenses            Franchise taxes                                         Real estate abatement fees 
Bad debt                       Furniture                                               Real estate fees 
Bank charges                   General expense                                         Real estate taxes  
Blanket insurance policies     Gifts                                                   Rebates 
Bond premium                   Ground rent                                             Recovery charges 
Building rent                  Health club/gym                                         Refunds 
Business insurance             Improvement loan                                        Reimbursements of any type 
Business organization expenses In rem payments                                         Renovations 
Cable service                  Income taxes                                            Rent 
Capital improvements           Insulation                                              Rent strike settlement 
Car fare                       Intercom                                                Reserves for replacement 
Certificate of occupancy costs Interest payments                                       Return of rent 
Certiorari costs               J51 exemption/abatement filing  Safe deposit boxes 
Christmas expenses             fee (421a filing fee)                                   Storage 
Claims of any kind             Janitor's apartment and/or utilities                    Superintendent's apartment 
Closing costs                  General expense                                         and/or utilities 
Commercial rent tax            Late charges                                            Tenant buyout 
Commitment costs               Lawsuit settlement                                      Tenant holdovers 
Common charges                 Lease cancellation costs                                Tenant moving expense 
Compactor                      Lease surrender                                         Tenant refund 
Computer purchases             Leasehold interest                                      Tenant's refund 
Construction                   Lien                                                    Termination fee 
Consultation fee (other than   Local law 5 or 10 filing fee                            Title insurance 
that specified for management  Management training                                     Transportation 
or leasing)                    Merchants association dues                              Travel 
Contributions                  Miscellaneous expense                                   Unincorporated business tax 
Corporation expenses           Mortgage Interest                                       Vacancy 
Corporation taxes              Negative (bracketed) amounts                            Vacancy and loss of rent 
Debt service                   Occupancy tax                                           Vacating expense 
Delivery expense               Office rent                                             Variance costs 
Demolition                     Officers' salaries                                      Violations 
Depreciation                   Organization expenses                                   Write off on leasing & renting 
Drawing                        Parking                                                 Zoning fees 
Dumpster                       Partners' salaries                                      Xmas expenses 
Electrical survey              Penalties 

                               Eligible Miscellaneous Expenses

Petty cash           Lease buy-out                   Special assessments                          Sundry

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Instructions for Worksheet RPIE-2020 - Gas station, car wash and oil change facilities Page 11

Reserve for Replacement Items

1. Air conditioning equipment and systems (roof-top)
2. Air conditioning units in existing sleeves replacement
3. Bathroom and kitchen exhaust fans
4. Bathroom cabinet/countertop/flooring replacement
5. Bathroom plumbing fixtures/controls/fittings replacement
6. Cooling plants (including cooling towers, piping and ductwork)
7. Decking replacement
8. Elevator upgrade/replacement
9. Emergency generators replacement/installation
10. Exterior door/storm door replacement/installation
11. Exterior painting/caulking/weatherproofing
12. Exterior siding replacement/installation
13. Gutter system replacement/installation
14. Hard-wired smoke detector system/carbon monoxide detector system
15. Heat/fire/smoke suppression systems
16. Heating equipment/controls replacement/installation
17. Heating plant components (boilers/furnaces, piping/ductwork and chimneys/flues) replacement/installation
18. Hot water heaters/controls replacement/installation
19. Kitchen appliance replacement
20. Kitchen cabinet/countertop/flooring replacement
21. Kitchen plumbing components/controls/fittings replacement
22. Laundry appliance replacement
23. Masonry re-pointing, minor brick replacement
24. Parking structure modification
25. Pool/tennis court/fitness center/playground replacement
26. Roof surface replacement/installation
27. Security systems replacement
28. Site grading and retaining wall replacement/installation
29. Site paving replacement/installation, including parking areas and sidewalks

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FILING DEADLINE: JUNE 1, 2021
RPIE-2020 CONFIDENTIAL

REAL PROPERTY INCOME AND EXPENSE FORM
Gas Station, Car Wash and Oil Change Facilities
Check Your Mailing Address: All owners must maintain a current mailing address for each prop-
erty with the NYC Department of Finance. To check your mailing address for this property, look at
the latest Property Tax Bill found. Mailing addresses can be updated online or by calling 311.

Address of Property: ____________________________________________________________________________________________

Borough: ________________________________________ Block:_______________________ Lot: ________________________
SECTION A - OWNER/FILER INFORMATION

1a. Owner’s Name: _____________________________________________________________________________________________
b. Owner’s Employer Identification Number: c. Owner’s Social Security Number:
OR

d. Additional Owner’s Name: _____________________________________________________________________________________
e. Additional Owner’s Employer Identification Number: f. Additional Owner’s Social Security Number:
OR

2a. Name of Entity Filing (if different from the owner): ___________________________________________________________________
b. Filer’s Employer Identification Number: c. Filer’s Social Security Number:
OR

d. Entity’s Relationship to the Property: ❑ Owner ❑ Lessee ❑ Owner Representative ❑ Lessee Representative
SECTION B - CONTACT INFORMATION

1. Contact Name: _____________________________________ 2. Firm Name:___________________________________________

3. Address:____________________________________________________________________________________________________
NUMBER AND STREET

City:______________________________________________ State: _____________ Zip Code: _________________________

4. Telephone #: ______________________________________ 5. E-mail Address: _______________________________________

SECTION D - RPIE EXCLUSIONS
To be completed ONLY if you are not required to File an RPIE for Tax Year 2020.
I am not required to file a RPIE for this year because my property:
a. ❑ has an Actual Assessed Value of $40,000 or less.
b. ❑ is exclusively residential with 10 or fewer apartments.
c. ❑ is primarily residential with 6 or fewer apartments and no more than one commercial unit, and is in Tax Class 1 or Tax Class 2.
d. ❑ is a residential cooperative apartment building with less than 2,500 square feet of commercial space (not including garage space).
e. ❑ is an individual residential unit that was sold and is not owned by the sponsor.
f. ❑ is rented exclusively to a related person or entity.
g. ❑ is occupied exclusively by the owner but is not a department store with 10,000 or more gross square feet; hotel or motel;
parking garage or lot; power plant; or other utility property; selfstorage warehouse; gas station; car wash or theater.
h. ❑ is owned and used exclusively by afully exempt not-for-profit organization or government entity and generates no rental income.
i. ❑ is vacant or uninhabitable and non-income-producing for the entire year.
j. ❑ is vacant, non-income-producing land.
k. ❑ The owner has not operated the property and is without knowledge of the income and expenses for the entire calendar or fiscal
year of the reporting period. 2.10.2021

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RPIE-2020 - Real Property Income & Expense Form - Gas Station / Car Wash / Oil Change Facilities Only Page 2

SECTION E - VACANCY INFORMATION

1
Percentage of Space that was vacant as of the taxable status date (January 5, 2021):
❑ Gas Station ___________% ❑ Oil Change Facility _________ % ❑ _________%
❑ Kiosk ___________% ❑ Convenience Store _________ %
❑ Car Wash ___________% ❑ Repair Shop _________ %

SECTION H - LEASE AND OCCUPANCY INFORMATION

1. Does the tenant lease the entire property? ❑ Yes ❑ No
2. Does the tenant pay utility expenses? ❑ Yes ❑ No
3. Does the tenant pay maintenance and repair expenses? ❑ Yes ❑ No
4. Does the tenant pay property tax for the space occupied? ❑ Yes ❑ No
5. What is the Annual Rent paid to the Property Owner? ______________
6. Is the net lessee or owner related party subleasing any of the property?
if YES, then please provide responses to questions 6a-c.
a) What is the Square Footage? ______________
b) What is the Use of Space? ______________
c) What is the Annual Rent? ______________
7. Are you filing as ground lessor?
if YES, then please respond to question 7a
a) What is the Ground Lease Amount that you are receiving? ______________

SECTION I - REPORTING PERIOD

1. The 2020 income and expense statement is for a: The 2019 income and expense statement is for a: The 2018 income and expense statement is for a:

❑ Calendar Year ❑ Fiscal Year ❑ Partial Year ❑ Calendar Year ❑ Fiscal Year ❑ Partial Year ❑ Calendar Year ❑ Fiscal Year ❑ Partial Year

2. Indicate the period covered in this statement: Indicate the period covered in this statement: Indicate the period covered in this statement:

Month Year Month Year Month Year Month Year Month Year Month Year

From ________/ 2020 To ________/ 2020 From ________/ 2019 To ________ / 2019 From ________/ 2018 To ________/ 2018

3. Name of the Facility: __________________________________________________________________________________________

SECTION K - INCOME Do not list any negative figures.
6 2020 2019 2018
Income ($ per year) Income ($ per year) Income ($ per year)
(Round to nearest $) (Round to nearest $) (Round to nearest $)

Gas Station / Car Wash / Oil Change
Facility Real Estate Rental Income
1. Rent

Business Income

1. Merchandise

2. Food and Beverage

3. Automotive Fuel

4. Other Sales (Car Wash, Repair Shop, Etc.)

5. Total Business Income

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RPIE-2020 - Real Property Income & Expense Form - Gas Station / Car Wash / Oil Change Facilities Only      Page 3
 SECTION K - INCOME (CON’T).  Do not list any negative figures.
6                                             2020                  2019                              2018 
                                              Income ($ per year)   Income ($ per year)               Income ($ per year) 
                                              (Round to nearest $)  (Round to nearest $)              (Round to nearest $) 
Other Income 
 
  1. Signage / Billboard 
 
  2. Cell Towers 
 
  3. Other (describe): 
 
    a. 
 
    b. 
 
    c. 
 
  4. Total Other Income  
 
Cost of Goods Sold 
 
 1. Merchandise 
  
 2. Food and Beverage 
 
 3. Automotive Fuel 
 
 4. Other Sales (Car Wash, Repair Shop, Etc.) 
 
 5. Total Cost of Goods Sold 
 
 6. Gross Profit of CGS (Total Business  
  Income less Total Cost of Goods Sold) 
 SECTION L - EXPENSES.  Do not list any negative figures.
                                              2020                  2019                              2018
    Expenses ($ per year)                     Expenses ($ per year) Expenses ($ per year) 
                                              (Round to nearest $)  (Round to nearest $)              (Round to nearest $) 
  
 1. Labor Costs 
  2. Insurance 
  3. Royalty Fees 
  4. Franchise Fees 
  5. Credit Card Fees   
  6. Supplies 
  7. Advertising 
  8. Property Maintenance and Repairs 
  9. Energy 
10. Management and Administration 
11. Motor Fuel Driveoffs 
12. Cash Short 
13. Other (describe): 
    a. 
    b.  
    c.  
14. Total Business Expenses

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RPIE-2020 - Real Property Income & Expense Form - Gas Station / Car Wash / Oil Change Facilities Only      Page 4
SECTION L - EXPENSES (CON’T).  Do not list any negative figures.
                                               2020                  2019                             2018 
                                               Expenses ($ per year) Expenses ($ per year)            Expenses ($ per year) 
                                               (Round to nearest $)  (Round to nearest $)             (Round to nearest $) 
 
Calculation of Adjusted EBIDTA 
1. Gross Profit of CGS + Rent 
    + Total Other Income 
2. Less Business Expenses 
    (#14 above) 
3. Adjusted EBIDTA 
SECTION L2 - RECAPITULATION, FURNITURE, FIXTURES AND EQUIPMENT.  Do not list any negative figures.
                                               2020                  2019                             2018 
                                               Expenses ($ per year) Expenses ($ per year)            Expenses ($ per year) 
                                               (Round to nearest $)  (Round to nearest $)             (Round to nearest $) 
 
Furniture, Fixtures and Equipment (FF & E) 
Used in Gas Station / Car Wash / Oil 
Change Facility 
 1. Is there a reserve for FF & E? 
  ❑ YES      ❑ NO 
 2. Contribution to reserve in reporting year 
 3. Cost of FF & E items purchased in 
  reporting year
                 
 4. Book cost of all FF & E at year end 
 
 5. Depreciation of FF & E for reporting year 
                                               
 6. Book cost less accumulated depreciation

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