Form A-5 - Land Use Change Tax Page 3
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3NEW HAMPSHIRE DEPARTMENT OF REVENUE ADMINISTRATION
FORM
A-5
LAND USE CHANGE TAX
INSTRUCTIONS
GENERAL INSTRUCTIONS
WHO MUST FILE
STEP 3
Local assessing officials shall complete Form A-5, Land Use Change
(a) Enter name and address of the owners of record when the land
Tax, to assess the use change tax on current use land where property
was first classified under Current Use, including the Book and
previously classified as open space land and assessed at current use
Page where it was recorded.
values on or after April 1, 1974 is changed to a use which does not
(b) Enter the number of acres originally classified under RSA 75:1.
qualify for current use assessment.
(c) Enter the number of acres previously disqualified from RSA 75:1.
(d) Enter the number of acres disqualified per this Assessment.
WHAT TO FILE
(e) Enter the number of acres remaining in Land Use Assessment.
The Form A-5 shall be prepared by the local assessing officials and an
[Steps 3(b) minus 3(c) and 3(d)].
original and two copies shall be submitted to the tax collector for
collection of land use change tax. In accordance with Cub 309.03 Form
STEP 4
A-5W shall serve as a warrant with which the tax collector shall collect
(a) Provide a brief narrative description of the property subject to
the tax. The tax collector shall ensure that a copy of these instructions
disqualification. (i.e. forest land converted to house lots.)
are provided to the land owner advising them of their appeal rights.
(b) Enter the actual date of change in use in the following format:
MM/DD/YYYY.
WHEN TO FILE
(c) Enter the full and true value of the disqualified property at the time
Pursuant to RSA 79-A:7, II(d), payment of Land Use Change Tax,
of the change in use.
together with the recording fees due the Register of Deeds, is due within
(d) Calculate the Land Use Change Tax by multiplying Step 4(c) by
30 days after mailing of the tax bill. Interest at a rate of 18% will accrue
10%. Enter the result on Step 4(d).
on any unpaid tax after 30 days.
STEP 5
WHERE TO FILE
Signatures, in black ink, of a majority of the local selectmen/assessors
Once completed and signed in black ink, this form and attachments
in the spaces provided indicates approval.
shall be filed as follows:
Original:
Register of Deeds
STEP 6
Enter the name and mailing address of the present owners or
Copy:
Local Assessing Officials
responsible party responsible for payment of tax.
Copy:
Land Owner
Copy:
Local Tax Collector
(a) Enter the actual date of the change in use. [Same as Step 4(b)].
(b) Enter the date of the Land Use Change tax notice.
APPEALS
(c) Enter the Full and True Value of the land subject to Land Use
Within 2 months of the notice of the tax date, and not afterwards, a
Change as provided in RSA 75:1. [Same as Step 4(d)].
land owner may apply in writing to the Selectmen or Assessors for an
(d) Enter the Land Use Change Tax Due as calculated on page 1
abatement of the Land Use Change Tax. If the Selectmen or Assessors
Step 4(d).
neglect or refuse to abate the Land Use Change Tax, any person
STEP 7
aggrieved may either apply in writing to the Board of Tax and Land
Appeals or petition the County Superior Court within 8 months of the
(a) Enter the municipality to which checks are to be made payable.
notice of the tax in accordance with RSA 79-A:10 or RSA 79-A:11.
This should be the municipality in which the disqualified property
Forms for appealing to the Board of Tax and Land Appeals may be
is located.
obtained from the NH Board of Tax and Land Appeals, 107 Pleasant
(b) Enter the name of the tax collector and the applicable mailing
Street, Concord, NH 03301 or by calling (603) 271-2578 or by visiting
address to which payments should be remitted.
their web site at Be sure to specify that you are
(c) Enter the tax collector’s office location.
appealing the Land Use Change tax.
(d) Enter the hours of operation for the local tax collector.
(e) Enter the applicable lien release recording fee to be remitted to
ADA
the County Registry of Deeds and the proper county to which the
Individuals who need auxiliary aids for effective communication in
fee is due.
programs and services of the department are invited to make their
(f) Enter the final date the taxpayer has to pay the bill to avoid
needs and preferences known to the NH Department of Revenue
penalties.
Administration.
STEP 8
NEED HELP?
The tax collector must sign and date in black ink to indicate when the
Contact your local municipality or the Property Appraisal Division at
tax is paid and then shall remit the original Form A-5 with the recording
(603) 230-5950.
fee to the County Registry of Deeds.
LINE-BY-LINE INSTRUCTIONS
STEP 1
Enter the complete name(s), address, municipality, state and zip code
of the present owner(s) and/or responsible party [if other than owner
pursuant to RSA 79-A:7, II(e)], being assessed the Land Use Change
Tax in accordance with RSA 79-A:7. If there is more than two owners,
submit a supplemental list of all owners names of record.
STEP 2
Enter the property location information of the land being disqualified in
the spaces provided. Check whether this is a partial release or a full
release.
Page 3 of 3
A-5
Rev 03/13
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