Source document: https://docs-lawep.s3.us-east-2.amazonaws.com/1697797068237.pdf (Dominica)
Form RRL Commonwealth of Dominica Inland Revenue Division Residential Rent Return of Income for the Year ended December 31st _____ Last Name First Name Middle Name(s) Tax Account Number Home Address Mailing Address (if different from home address) Name & Address of Employer Sex M F Date of Birth Social Security Number Nationality Marital Status Name of Spouse Telephone Number (Home) Telephone Number (Work) Telephone Number (Mobile) Occupation Email Address COMPUTATION OF NET INCOME 1000 Total Residential Rent Income 1001 Less: Allowable Interest Expense Deductions (Attached Interest statements from Financial Institutions) 1002 Less: Property Insurance (Attached Cover Notes from Insurance Companies) 1003 Total deductions (Add line 1001 & 1002 ) 1004 Chargeable Income (subtract line 1003 from line 1000) 1000 1001 1002 1003 1004 Enter Chargeable Income from line 1004 x 20% 1005 Total tax payable on Chargeable Income Tax Payable 1.
Make cheque or money order payable to the COMPTROLLER OF INLAND REVENUE.

DO NOT MAIL CASH 2.

3.

4.

Return MUST be filed ON or BEFORE MARCH 31ST.

Any balance due MUST be paid ON or BEFORE MARCH 31ST A 10% PENALTY AND INTEREST AT 1% PER MONTH OR PART THEREOF will be charge on payments made after MARCH 31ST If you require assistance in completing this form, contact the Inland Revenue at telephone number 266-3600 5.
CERTIFICATE OF DISCLOSURE I hereby certify that the information given in this return is TRUE, CORRECT and COMPLETE in every respect and FULLY DISCLOSES my TAXABLE INCOME from ALL SOURCES Name Date Day Month Year Signature George1 James CresentGloria2 5 0 0*10 11 68GoodwillGovernment of DominicaDominicanSingle235-4000Senior Clerk28,800 008,193 982,210 5310,404 5118,395 4918,395 493,679 10Gloria George20 2 20