Cost Segregation Information Request

Name
Title
Organization
Work Phone		Fax
Home Phone		Email
Street Address
Address (cont.)
City
State/Province		Zip Code
Web Site
Name of Entity Holding the Real Estate
Date Building Placed In Service
Building Cost	Land Cost
How Acquired	Purchased   Constructed
How many years does the property owner intend on holding the property?
Subsequent Building Improvements		Yes  No
If Yes, Amount Expended
If Yes, Date Placed In Service
In the Box Below, Please Enter a Brief Description of the Building.
Example 1:  120 unit garden style apartment complex Example 2:  20,000 square foot 2 story office bldg w/ no parking lot in downtown Detroit
If Constructed, Are the Following Items Available?   Final Application for Payment (AIA Document) Yes No   Construction Drawings Including Mechanicals Yes No If Purchased, Are the Following Items Available?   Construction Drawings Including Mechanicals Yes No   Site Plan and/or Survey Yes No   Appraisal Yes No
Use The Box Below To Enter Additional Comments or Questions.
Thank You!