Get IN State Form 21926 - Schedule LIC 2011-2023
With annual state tax liability return.) Enclosure Sequence No. 28 Section A - Taxpayer Information Name of Taxpayer (lender) Social Security or Federal Identi cation Number Street Address County City or Town, State, and ZIP Code Taxpayer's Telephone Number ( ) Section B - Quali ed Loan Information (attach list of all borrowers) Section B continued on reverse side. Name of Borrower (A) Borrower's Social Security or Federal Identi cation Number Street Address Borrower's Telephon.
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