Form Pa-47 - Community Revitalization Tax Relief Incentive Penalty
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NEW HAMPSHIRE DEPARTMENT OF REVENUE ADMINISTRATION
FORM
PA-47
COMMUNITY REVITALIZATION TAX RELIEF INCENTIVE PENALTY
PROPERTY OWNER’S LAST NAME
FIRST NAME
INITIAL
STEP 1
PROPERTY
OWNER(S)
PROPERTY OWNER’S LAST NAME
FIRST NAME
INITIAL
MAILING ADDRESS
CITY/TOWN
STATE
ZIP CODE
STEP 2
STREET ADDRESS
PROPERTY
LOCATION
CITY/TOWN
COUNTY
CITY/TOWN TAX MAP #
LOT#
BLOCK #
BOOK #
PAGE #
STEP 3
MARKET VALUE ASSESSMENT
$
COMMUNITY
REVITALIZA-
TION TAX
TAX RATE
$
RELIEF
INCENTIVE
TAXES DUE
$
PENALTY
INTEREST RATE (12% per annum on all taxes that would have been due and payable)
$
TOTAL AMOUNT PAYABLE
$
STEP 4
TYPE OR PRINT NAME
SIGNATURE (IN INK)
DATE
SIGNATURE
OF
TYPE OR PRINT NAME
SIGNATURE (IN INK)
DATE
APPROVAL
MAJORITY
OF SELECT-
TYPE OR PRINT NAME
SIGNATURE (IN INK)
DATE
MEN/ASSES-
SORS
TYPE OR PRINT NAME
SIGNATURE (IN INK)
DATE
TYPE OR PRINT NAME
SIGNATURE (IN INK)
DATE
STEP 5
(a) Make Check Payable to:
CHECKS
PAYABLE
(b) Mail to:
Name:
TO AND
MAILED TO
Address:
Town/City
State
Zip Code
TO BE COM-
PLETED BY
(c)
Tax Collector’s Offi ce Location
TAX COL-
LECTOR
(d) Tax Collector’s Offi ce Hours
(e) 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 before:
PA-47
Rev. 3/13
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