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? Refinance Sale Name of Owner(s) (For Refinance) or Buyer(s) (for Sale) Address of Property Refinance or Purchased Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code COMPLETE FOR EACH INDIVIDUAL WHO WILL RESIDE AT THIS ADDRESSFull NameAgeSocial Security No. Last 4 OnlyName of EmployerAddress of EmployerPhone Number Add Remove*If self-employed, list company name and addressUNDER 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 Add RemovePlease type your full name below to serve as your electronic signature.
