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Room Information: 2. 3. 4. 5. 6. 7. 8. Annual Rate: Daily Average # of room s unable to be occupied and why: Annual Occupancy Rate: Expense Ratio: 1. Single All information including the accompanying schedules and statements have been examined by me and to the best of my knowledge and belief are true, correct, and complete. Contact Person: Management Firm (if applicable) Address: Phone: Date: Allen County Hotel/Motel Survey Allen Assessor Rousseau Fort Ph - 260 -3 449 115 Fax - - [PHONE REDACTED] 46802 IN Wayne 415 Suite Street Main E 1 Centre, O'Day Stacey - County # Units Average Rate Weekly $ $ $ $ $ $ $ $ $ Signature: Average Rate Daily Title: Per IC 6-1.1-35-9, any information pertaining to income expense is constitutionally protected and will remain confidential. Double King Suite Other (List) Other (List) Other (List) Other (List) $ $ $ $ $ $ $ property this of assessment the towards pertinent be would feel you Information : Additional Owner: Mailing Address: Contact Number: E-Mail Address: Name of Preparer: Hotel/Motel Name: Property Address: Parcel Number *As part of data submission, please include the last three years (2023-25) of Federal income & expense records