Form Pa-30-Elderly And Disabled Tax Deferral Application

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FOR REGISTER OF DEEDS USE ONLY
Print and Reset Form
NEW HAMPSHIRE DEPARTMENT OF REVENUE ADMINISTRATION
FORM
ELDERLY AND DISABLED TAX DEFERRAL APPLICATION
PA-30
DUE MARCH 1st FOLLOWING THE NOTICE OF TAX
PLEASE TYPE OR PRINT
STEP 1
LAST NAME
FIRST NAME
PROPERTY
OWNER(S)
LAST NAME
FIRST NAME
STREET ADDRESS
ADDRESS (CONTINUED)
TOWN/CITY
STATE
ZIP CODE
PLEASE TYPE OR PRINT
STREET
STEP 2
PROPERTY
LOCATION
TOWN/CITY
COUNTY
NUMBER OF ACRES
MAP #
LOT #
BOOK #
PAGE #
(a) Tax year for which the deferral is requested
STEP 3
TO BE
(b) Amount of requested tax deferral
$
COMPLET-
ED
(c)
Amount of Tax Bill
$
BY THE
(d) Tax year for which the deferral is requested
Yes
No
PROPERTY
Is age 65 or older, or
OWNER
Receives benefi ts under Title II or Title XVI of the Federal Social Security act.
And, the applicant has owned and lived in home for more than 5 years if elderly or for
at least 1 year if disabled.
STEP 4
I understand that upon approval of this application, by the local assessing offi cials, a deferral shall be created
PROP-
against the previously described property, pursuant to RSA 72:38-a. My signature below indicates my agree-
ERTY
ment with the obligation incurred against the property described in Step 2 above.
OWN-
TYPE OR PRINT NAME (IN BLACK INK)
SIGNATURE (IN BLACK INK)
DATE
ERS
SIGNA-
TYPE OR PRINT NAME (IN BLACK INK)
SIGNATURE (IN BLACK INK)
DATE
TURES
TYPE OR PRINT NAME (IN BLACK INK)
SIGNATURE (IN BLACK INK)
DATE
TYPE OR PRINT NAME (IN BLACK INK)
SIGNATURE (IN BLACK INK)
DATE
Page 1 of 3
PA-30
Rev 6/2008

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