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Ctual (not preliminary) tax payment for fiscal year. INSTRUCTIONS: Complete BOTH sides of application. Please print or type. A. TAXPAYER INFORMATION. Name(s) of assessed owner: Name(s) and status of applicant (if other than assessed owner) Subsequent owner (aquired title after January 1) on Mortgagee. Administrator/executor. Other. Specify. Lessee. Mailing address No. , Telephone No. ( Street City/Town ) Zip Code Amounts and dates of tax payments.

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