Property Supplemental Income Form

Income or Loss From Rental Real Estate and Royalties

A Did you make any payments in 2021 that would require you to file Form(s) 1099? (see instructions)

YesNo

B If “Yes,” did you or will you file required Forms 1099?

YesNo

1a

Physical address of each property (street, city, state, ZIP code)

A

B

C

1b

Type of Property (from list below)

A

B

C

2 For each rental real estate property listed above, report the number of fair rental and personal use days.

Fair Rental Days

Personal Use Days

A

B

C

Type of Property:

1 Single Family Residence

3 Vacation/Short-Term Rental

5 Land

7 Self-Rental

2 Multi-Family Residence

4 Commercial

6 Royalties

Other

Income:

Properties:

A

B

C

3 Rents received

3

4 Royalties received

4

Expenses:

5 Advertising

5

6 Auto and travel (see instructions)

6

7 Cleaning and maintenance

7

8 Commissions

8

9 Insurance

9

10 Legal and other professional fees

10

11 Management fees

11

12 Mortgage interest paid to banks, etc. (see instructions)

12

13 Other interest

13

14 Repairs

14

15 Supplies

15

16 Taxes

16

17 Utilities

17

18 Depreciation expense or depletion

18

19 Other

19

20 Total expenses. Add lines 5 through 19

20

Signature of Taxpayer:     

Signature of Spouse:     

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