Form Pa-9 - Certification Of Yield Taxes Assessed Page 2
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NEW HAMPSHIRE DEPARTMENT OF REVENUE ADMINISTRATION
PA-9
CERTIFICATION OF YIELD TAXES ASSESSED
INSTRUCTIONS
DUE ON OR BEFORE MAY 15th OF EACH YEAR
ITEM # 1
Person signing line #7 of the Report of Cut Form (PA-8) and responsible for any yield tax assessed.
Name of Owner
ITEM # 2
Name and/or tax map number designateed to the Lot on Line #2 of the Report of Cut Form (PA-8).
Name & Tax Map No.
ITEM # 3
Number stamped by the Department of Revenue Administration in the upper right hand corner of the Report of Cut Form (PA-8).
Operation Number
ITEM # 4
Species reported cut under Line # 8 of the Report of Cut Form (PA-8).
Species
ITEM # 5
Volume reported by the Operator under Line #8 of the Report of Cut Form (PA-8).
Number of MBF, Tons
or Cords
ITEM # 6
Check the type of measurement used.
MBF, Tons or Cords
ITEM # 7
Values assessed by Selectmen/Assessors against each of the species reported under Line #8 of the Report of Cut Form (PA-8). (Refer to thesuggested average stumpage
values furnished by the Department of Revenue Administration.)
Stumpage Value
ITEM # 8
Determined by multiplying Item #5 by Item #7.
Total Assessed Valuation
10 percent of Item #8 equals Item #9.
ITEM # 9
Tax @ 10%
Total of Item #9 for each Operation Number. This results in the total tax due for each Report.
ITEM #10
Total Tax Due
SEND ONE COPY TO THE DEPARTMENT OF REVENUE ADMINISTRATION
PA-9
Rev. 8/2012
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