Form Pa-20-E - Utility Property Tax List Of Pollution Control Exemption Rsa 72:12-A Page 2

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NEW HAMPSHIRE DEPARTMENT OF REVENUE ADMINISTRATION
FORM
PA-20-E
UTILITY PROPERTY TAX
LIST OF POLLUTION CONTROL EXEMPTION RSA 72:12-A
Reset Form
Name of Owner
Federal Employer Identifi cation Number
Identify Each New Hampshire DES Exempted Item
City/Town Asset
DES %
Original Cost
(Attach a brief description of each)
Location in NH
Exempt
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30
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CERTIFICATION: I hereby certify under penalties of perjury that the information provided on the accompanying pages, is correct, and accurate to the
best of my belief and knowledge, and that I am authorized to submit this report on behalf of the utility property owner and/or operator named herein.
SIGNATURE (IN INK)
DATE
PRINT SIGNATORY NAME & TITLE
NH DRA
PROPERTY APPRAISAL DIVISION
MAIL TO:
ATTN: UTILITY APPRAISAL
PO BOX 487
CONCORD, NH 03302-0487
PA-20-E
2 of 2
Rev. 2/2008

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