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READ INSTRUCTIONS ON BACK BEFORE COMPLETING FORM ATTACH ADDITIONAL PAGES IF NECESSARY o ORIGINAL COMPLAINT o COUNTER-COMPLAINT TAX YEAR COUNTY NOTICES WILL BE SENT ONLY TO THOSE NAMED BELOW Name Street Address, City, State, Zip Code 1) Owner of property 2) Complainant if not owner 3) Complainant's agent 4) Telephone number of contact person ( ) 5) Complainant's relationship to property if not owner If more than one parcel is included, see "Multiple.

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