Form Pa-9 - Certification Of Yield Taxes Assessed
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NEW HAMPSHIRE DEPARTMENT OF REVENUE ADMINISTRATION
PA-9
CERTIFICATION OF YIELD TAXES ASSESSED
Under penalties of perjury, I declare that I have examined the
FROM: TOWN/CITY
information contained in this form and to the best of my belief it
is true, correct and complete.
DATE:
SUMMARY OF TOTAL YIELD TAX ASSESSED........10%
(Total of All Column #10)
SELECTMEN SIGNATURE
COUNTY:
TO:
DEPT. OF REVENUE ADMINISTRATION
SELECTMEN SIGNATURE
PROPERTY APPRAISAL DIVISION
109 PLEASANT STREET, PO BOX 487
SELECTMEN SIGNATURE
CONCORD, NEW HAMPSHIRE 03302-0487
NOTE: EACH TIME A WARRANT IS SUBMITTED FOR TIMBER TAX, IT IS SUGGESTED THAT THE INFORMATION BE ENTERED ON THIS FORM.
#1
#4
#5
#6
#7
#8
#9
#10
NUMBER OF
CHECK ONE
STUMPAGE
TOTAL
NAME OF OWNER
SPECIES
MBF
TNS
CDS
MBF, TNS, CDS
VAL. ASSESSED
ASSESSED VAL.
TAX AT 10%
WHITE PINE
HEMLOCK
TOTAL TAX
RED PINE
DUE ON THIS
SPRUCE & FIR
#2
OPERATION
(NAME) AND/OR TAX MAP NO.
HARD MAPLE
by which lot was designated in
WHITE BIRCH
Notice of Intent
(TOTAL OF COL. #9)
YELLOW BIRCH
MAP #
LOT #
OAK
#3
ASH
BEECH & S. MAPLE
$
PALLET/TIE LOGS
OPERATION NUMBER
OTHERS: SPECIFY
SPRUCE & FIR
HARDWOOD & ASPEN
PINE
HEMLOCK
TOTAL TREE CHIPS
BIRCH BOLTS
CORDWOOD/FUELWOOD
WHEN THE CERTIFICATION IS MADE FOR MORE THAN ONE OPERATION, ADDITIONAL SHEETS ALLOWING TWO OPERATIONS PER SHEET MUST BE USED.
PA-9
IMPORTANT
Rev. 8/2012
SUMMARIZE TOTAL YIELD TAXES SUBMITTED FOR VERIFICATION ON PAGE ONE (THIS PAGE) WITH SELECTMENS’ SIGNATURES AFFIXED.
NOTICE
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