10-355 Form 10-355 Financial Information for Revenue Producing

NPS Form 10-355 (Rev. 04/2017) OMB Control No. 1024-0233

National Park Service Expiration Date ##/##/####

FINANCIAL INFORMATION FOR REVENUE-PRODUCING USES

NPS Leasing Program

Commercial Services Division

1849 C Street, NW

Washington, DC 20240

I. START UP COSTS
Working Capital	Utility Hookups
     	     
Improvements	FF&E
     	     
Marketing	Legal
     	     
Total Start Up Costs
     
Explain the basis of all estimates. The estimates must credibly demonstrate your understanding of the start-up costs associated with this lease opportunity.
II. Stabilized Operating Proforma
Revenue	Expenses
     	     
General/Administrative	Operations
     	     
Building Maintenance	Grounds Upkeep
     
HVAC	Utilities
	     
Security
     
Other Expenses:
Total Expenses	Net Income After Expenses
     	     
Annual Cost of Debt and Equity	Rent to NPS
     	     
Net Cash Flow
     
Explain the basis of all estimates. These estimates must credibly demonstrate that your net revenue will be sufficient to permit payment of the proposed rent and otherwise demonstrate that your proposal is financially viable.

NOTICES

Paperwork Reduction Act Statement

Paperwork Reduction Act Statement. We collect this information under the authority of Title IV of the National Parks Omnibus Management Act of 1998 (Pub. L. 105-391). We use this information to evaluate proposals received in response to leasing opportunities. Your response is required to obtain or retain a benefit. We estimate that it will take you 1 hour to complete this form. This estimate includes time for reviewing instructions, gathering and maintaining data, and completing and reviewing the form.

You may send comments on the burden estimate or any aspect of this form to the Information Collection Clearance Officer, National Park Service, 1849 C Street, NW, (2601), Washington, DC 20240. We may not collect or sponsor and you are not required to respond to a collection of information unless it displays a currently valid OMB control number.

Estimated Burden Statement

We estimate that it will take you 1 hour to complete this form, including time to review instructions, gather and maintain data, and complete and review the form. You may send comments on the burden estimate or any aspect of this form to the Information Collection Clearance Officer, National Park Service, 12201 Sunrise Valley Drive, Mail Stop 242, Reston, VA 20192. Please do not send your completed form to this address.

RECORDS RETENTION: TEMPORARY. Destroy/delete 3 years after closure. (NPS Records Schedule, Resource Management and Page 1 of 3

Lands (Item 1D) (N1-79-08-1))