Form Pa-37-A - Discretionary Preservation Easement Release
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3FOR REGISTER OF DEEDS USE ONLY
NEW HAMPSHIRE DEPARTMENT OF REVENUE ADMINISTRATION
FORM
DISCRETIONARY PRESERVATION EASEMENT RELEASE
PA-37-A
STEP 1 PROPERTY OWNER (S)
LAST NAME
FIRST NAME
LAST NAME
FIRST NAME
STREET ADDRESS
ADDRESS (CONTINUED)
TOWN/CITY
STATE
ZIP CODE
STEP 2 PROPERTY LOCATION
STREET
TOWN/CITY
COUNTY
NUMBER OF ACRES
MAP #
LOT #
BOOK #
PAGE #
OWNER NAME OF RECORD WHEN LAND WAS FIRST GRANTED DISCRETIONARY PRESERVATION EASEMENT
DISCRETIONARY PRESERVATION EASEMENT RECORDED IN:
CHECK ONE;
BOOK #
PAGE #
PARTIAL RELEASE
FULL RELEASE
STEP 3 TO BE COMPLETED BY ASSESSING OFFICIALS
Reason for Release:
Expiration
Personal Hardship
Other
Date of Release
Full and True Value at time of Release $
Discretionary Preservation Easement Tax ............................................... $
STEP 4 SIGNATURES OF ALL PROPERTY OWNERS OF RECORD, IF APPLICABLE
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-37-A
Page 1 of 3
Rev. 4/03
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