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Section A: Owner/Filer Information Owner Name: Business Name: Mailing Address: Contact E-Mail Address: Section B: Property Information Business Name: Property Address: Gross Sq Ft: Parcel(s): Section C: General Information Property is 100% owner occupied: Yes No If the answer is yes, please complete 1st page H Section and and return to the above address. If the answer is no, please complete the remaining pages and return to the above address. Lease Type: Net Double Net Triple Net Gross Building Square Ft: Net Leasable Square Ft: Section D: Vacancy Information Section E: Capital Improvements, Renovations Has the property had Capital improvements or Capital renovations during the reporting period? Yes No If yes, please provide a total cost here and attach a detailed list of improvements on a separate page. Total Capital Cost: Do you fund a reserve for future capital improvements? Yes No If yes, what is the annual amount? Section F: Appraisals & Sales Appraisal information: Has there been a professional appraisal on this real property in the last 5 years? Yes No If yes, appraiser's estimate of value of value: Section G: Sales Information: Date Acquired: Date Sold: Is the property currently available for sale: Section H: Please submit your last three years (2023, 2024, & 2025) Federal Income & Expense Information to complete this filing. 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: $ $ Title: Signature: 1 Per IC 6-1.1-35-9, any information pertaining to income expense is constitutionally protected and will remain confidential. Allen County Restaurant Survey Allen County Assessor - Stacey O'Day Rousseau Centre, 1 E Main Street Suite 415 Fort Wayne IN 46802 Ph [PHONE REDACTED] Fax [PHONE REDACTED] 2025 sq ft rentable % vacant 2024 sq ft rentable % vacant Actual loss of income in 2025 from bad accounts: Current market rent per sq ft for vacant space: