FORM
NEW HAMPSHIRE DEPARTMENT OF REVENUE ADMINISTRATION
PA-33
STATEMENT OF QUALIFICATION
For Property Tax Credit or Exemption Under RSA 72:33,V
(to be submitted with Form PA-29)
USE THIS FORM ONLY IF YOUR PROPERTY IS HELD IN A TRUST OR AS A LIFE ESTATE
WHO
To be completed by property owners wishing to establish their status as holding equitable title/the benefi cial
interest owner of a trust, or holding a life estate in a property.
Chapter 102, Laws of 1994 has made it possible for a property owner to put their property into a trust or life
WHY
estate and still be eligible for the property tax credit or exemption for which they were qualifi ed.
WHEN
This completed form shall be submitted with the Permanent Application Form PA-29 (RSA 72:33) for property
tax credit or exemption, to the local assessing offi cials of the City/Town in which such application is fi led. The
completed Form PA-33 becomes a permanent document and does not need to be refi led unless the status of
the trust or life estate is changed or altered.
LAST NAME
FIRST NAME
INITIAL
MAILING ADDRESS
CITY/TOWN
STATE
ZIP CODE
LOCATION OF PROPERTY:
ADDRESS
CITY/TOWN
I am eligible for a property tax credit or exemption against the property for which a Permanent Application Form PA-29, has
been made, and do qualify as the owner of the property under 72:29,VI based upon the following: (check one)
Equitable title holder, life interest or benefi cial interest owner of a trust
If this statement is checked, you must supply a copy of:
(a)
a Trust Instrument as defi ned in RSA 564-B:1-103 (20) OR
(b)
a Certifi cation of Trust prepared in accordance with RSA 564-B:10.
Name of Trust: _____________________________________________________________________
Life estate owner
If this statement is checked, you must supply a copy of the deed showing the assigned ownership of the life estate.
All documents submitted shall be handled to protect the privacy of the applicant.
Explanation or additional details:
Under penalties of perjury, I declare that I have examined this document and to the best of my belief the information herein
is true, correct and complete.
X
SIGNATURE (IN INK)
DATE
PRINT NAME
TELEPHONE NUMBER
PA-33
Rev 01/2011
1
