Form Pa-49 - Farm Structures & Land Under Farm Structures Assessment Use Change Release Page 2
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NEW HAMPSHIRE DEPARTMENT OF REVENUE ADMINISTRATION
FARM STRUCTURES & LAND UNDER FARM STRUCTURES
PA-49
ASSESSMENT USE CHANGE RELEASE
(CONTINUED)
STEP 4 SIGNATURES OF A MAJORITY OF SELECTMEN/ASSESSORS
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
TYPE OR PRINT NAME (in black ink)
SIGNATURE (in black ink)
DATE
STEP 5 FARM STRUCTURES & LAND UNDER FARM STRUCTURES ASSESSMENT USE CHANGE TAX BILL
LAST NAME
FIRST NAME
STREET ADDRESS
ADDRESS (continued)
TOWN/CITY
STATE
ZIP CODE
(a) Actual Date of Release (
)
MM/DD/YYYY
(b) Date of Use Change Tax Bill (
)
MM/DD/YYYY
(c) Full and True Value of Farm Structure & Land at Time of Release $
(d) Total Tax Due
$
STEP 6 CHECKS PAYABLE TO AND MAILED TO - TO BE COMPLETED BY TAX COLLECTOR
(a) Make Check Payable to:
NAME
(b) Mail To:
ADDRESS
TOWN/CITY
STATE
ZIP CODE
(c) Tax Collector's Offi ce Location:
(d) Tax Collector's Offi ce Hours:
(e) Include a separate check in the amount of $
Payable to
County Register of Deeds for recording fee.
(f) Payment of this tax is due no later than 30 days after mailing of this bill. Interest, at the rate of
18% per annum, shall be due if this tax is not paid on or before
STEP 7 ACKNOWLEDGMENT OF PAYMENT
SIGNATURE (IN BLACK INK) OF TAX COLLECTOR
DATE PAID
PA-49
Page 2 of 3
Rev. 3/13
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