Form Pa-36 - Discretionary Easement Application
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3FOR REGISTER OF DEEDS USE ONLY
NEW HAMPSHIRE DEPARTMENT OF REVENUE ADMINISTRATION
FORM
DISCRETIONARY EASEMENT APPLICATION
PA-36
STEP 1 PROPERTY OWNER (S)
LAST NAME
FIRST NAME
LAST NAME
FIRST NAME
STREET ADDRESS
ADDRESS (CONTINUED)
TOWN/CITY
STATE
ZIP CODE
STEP 2 PROPERTY LOCATION
STREET
TOWN/CITY
COUNTY
NUMBER OF ACRES IN PARCEL
NUMBER OF ACRES IN REQUESTED EASEMENT
MAP #
LOT #
BOOK #
PAGE #
TAX YEAR
Original Application
Renewal
CHECK ONE:
STEP 3 REASON FOR DISCRETIONARY EASEMENT APPLICATION
Preservation of a Golf Course
Preservation of an airport
Preservation of Open Space
Preservation of land for outdoor recreation by/or for the education of the general public
Description of Public Benefit:
STEP 4 SIGNATURES OF ALL PROPERTY OWNERS OF RECORD
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
PA-36
Page 1 of 3
Rev. 3/13
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Parent category: Financial