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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

    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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