Industrial Revenue Bond Informational Statement Page 3
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3IRB Informational Statement
Page 3 of 3
VERIFICATION
I, ________________________________, do solemnly swear or affirm that the information set forth
herein is true and correct, to the best of my knowledge and belief. So help me God.
_____________________________________
Signature of Applicant
_____________________________________
Printed Name and Title
State of ____________________
)
County of __________________
)
This instrument was acknowledged before me on __________ by ______________________________.
Seal
_____________________________________
Signature of Notary Public
My appointment expires: ________________
___________________________________________________________________________________
Send this statement along with the filing fee to:
Kansas Board of Tax Appeals
Eisenhower State Office Building
700 SW Harrison, Ste 1022
Topeka, KS 66603
__________________________________________________________________________________
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