Form Pa-47w - Community Revitalization Tax Relief Incentive Penalty Tax Collector'S Warrant

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NEW HAMPSHIRE DEPARTMENT OF REVENUE ADMINISTRATION
FORM
COMMUNITY REVITALIZATION TAX RELIEF INCENTIVE PENALTY
PA-47W
TAX COLLECTOR'S WARRANT
TAX COLLECTOR'S WARRANT FOR TOWN/CITY
TOWN/CITY OF
STREET ADDRESS
ADDRESS (continued)
TOWN/CITY
STATE
ZIP CODE
COLLECTION OF COMMUNITY REVITALIZATION TAX RELIEF INCENTIVE PENALTY
State of New Hampshire, County of
To
Collector of Taxes
for the Town/City of
in said County.
In the name of said State you are directed to collect the
COMMUNITY REVITALIZATION TAX RELIEF INCENTIVE
$
PENALTY in the list herewith committed to you, amounting in
all the sum of:
Interest at 18% will be assessed after 30 days.
Given under our hands at
This day of
OWNER NAME
OWNER ADDRESS
MAP
LOT
SIGNATURES OF A MAJORITY OF SELECTMEN/ASSESSORS
TYPE OR PRINT NAME (in black ink)
SIGNATURE (in black ink)
DATE
TYPE OR PRINT NAME (in black ink)
SIGNATURE (in black ink)
DATE
TYPE OR PRINT NAME (in black ink)
SIGNATURE (in black ink)
DATE
TYPE OR PRINT NAME (in black ink)
SIGNATURE (in black ink)
DATE
TYPE OR PRINT NAME (in black ink)
SIGNATURE (in black ink)
DATE
PA-47W
Rev 8/2012

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