HOME MORTGAGE INTEREST DEDUCTION 
PREPARE A SEPARATE WORKSHEET FOR EACH LOAN
EMAIL OR CALL US IF YOU HAVE QUESTIONS 

ADDRESS OF HOME: ___________________________________________________________________________________________

DATE PURCHASED: _________________________________________

NAME OF MORTGAGE COMPANY: _______________________________________________________________________________

ORIGINAL DATE OF LOAN: __________________________________

ORIGINAL LOAN BALANCE: _________________________________

PART OF LOAN THAT WAS USED TO PURCHASE OR SUSBSTANTIALLY IMPROVE HOME: ______________________________

LOAN BALANCE ON 12/31/2021: _______________________________
LOAN BALANCE ON 12/31/2022: _______________________________




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To the best of my knowledge, I attest that the above is true and accurate:

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_________________________________________ _____________  _____________________________________________  _______________
SIGNED (TAXPAYER)                                                                      DATED                   SIGNED (SPOUSE IF APPLICABLE)                                                  DATED
 
 
INTERNAL USE: 
REVIEWED: ___________________________________________  DATED: _________________

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