Earned Income Tax Questionnaire

This form must be completed and returned to the Borough Office prior to the issuance of a no-lien letter.
Is this a sale or refinance?
Address of Property Refinance or Purchased
COMPLETE FOR EACH INDIVIDUAL WHO WILL RESIDE AT THIS ADDRESS
Full Name
Age
Social Security No. Last 4 Only
Name of Employer
Address of Employer
Phone Number
 
*If self-employed, list company name and address

UNDER PENALTY OF LAW, I/WE CERTIFY THAT THE ABOVE INFORMATION IS CORRECT.

(MUST BE SIGNED BY ALL PROPERTY OWNERS OR REPRESENTATIVE OF RELOCATION COMPANY)
Signatures
Please type your full name below to serve as your electronic signature.