Form Pa-49w - Farm Structures & Land Under Farm Structures Use Change Tax Collector'S Warrant

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NEW HAMPSHIRE DEPARTMENT OF REVENUE ADMINISTRATION
FORM
FARM STRUCTURES & LAND UNDER FARM STRUCTURES
PA-49W
USE CHANGE 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 FARM STRUCTURES & LAND UNDER FARM STRUCTURES USE CHANGE TAX
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 FARM
$
STRUCTURES & LAND UNDER FARM STRUCTURES 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-49W
Rev. 3/13

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