Form Pa-36-A - Discretionary Preservation Easement Application Page 3
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NEW HAMPSHIRE DEPARTMENT OF REVENUE ADMINISTRATION
PA-36-A
DISCRETIONARY PRESERVATION EASEMENT APPLICATION
GENERAL INSTRUCTIONS
Form PA-36-A, Discretionary Preservation Easement Application, shall be used by owners of historic agricultural structures applying
WHO
MUST
for a discretionary preservation easement in accordance with RSA 79-D:3.
FILE
WHAT
Land owners submitting a completed application, Form PA-36-A, shall also:
TO
Submit a map showing:
FILE
(a) The location of the historic agricultural structure; and
(b)
The number of square feet to be included in the discretionary preservation easement.
WHEN
A completed Form PA-36-A, and a map of the land to be subject to the discretionary preservation easement must be filed on or before
TO
April 15 of the tax year the easement is to be granted.
FILE
WHERE
Once completed and signed in black ink, this form and attachments shall be filed as follows:
TO
Original:
Register of Deeds
FILE
Copy:
Local Assessing Officials
Copy:
Land Owner
APPEALS
If an application for a discretionary preservation easement is denied, an applicant may appeal within six months of any such action
by the assessing officials in writing to the New Hampshire Board of Tax & Land Appeals or the County Superior Court in accordance
with RSA 79-A:9 or RSA 79-A:11.
Forms for appealing to the Board of Tax and Land Appeals may be obtained from the NH Board of Tax and Land Appeals, 107 Pleasant
Street, Concord, NH 03301 or by calling (603) 271-2578 or by visiting their web site at Be sure to specify that
you are appealing a Discretionary Preservation Easement Application denial.
ADA
Individuals who need auxiliary aids for effective communication in programs and services of the department are invited to make their
needs and preferences known to the NH Department of Revenue Administration.
NEED
Contact your local municipality or the Property Appraisal Division at (603) 230-5950.
HELP
LINE-BY-LINE INSTRUCTIONS
STEP 1
Enter the complete name(s), address, municipality, state and zip code of the property owner(s) requesting a discretionary preservation
easement under RSA 79-D:3.
STEP 2
Enter the location information of the land and Historic Agricultural Structure being classified in the spaces provided. Check whether
original application or renewal and enter the tax year the easement is to be granted.
Describe how the Historic Agricultural Structure meets the requirements of RSA 79-D:3 and how many square feet will be subject
STEP 3
to the easement. Submit additional sheets, if necessary.
All owners of record must type or print their full name, sign and date in black ink on the lines provided. If there are more then four
STEP 4
owners, submit a supplemental list of all additional owners names and signatures.
To be completed by the local assessing officials, indicating approval or denial pending final approval of selectmen or assessors.
STEP 5
Signatures of a majority of the local selectmen or tax assessors on the lines provided indicates final approval.
STEP 6
Indicate whether a map has been included as described.
STEP 7
If the map is missing or this application is incomplete, this application shall be denied in accordance with RSA 79-D:4,II.
PA-36-A
Instructions
Page 3 of 3
Rev. 3/13
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