Form Pa-30 - Elderly And Disabled Tax Deferral Application

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FOR REGISTER OF DEEDS USE ONLY
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FORM
NEW HAMPSHIRE DEPARTMENT OF REVENUE ADMINISTRATION
PA-30
ELDERLY AND DISABLED TAX DEFERRAL APPLICATION
DUE MARCH 1st FOLLOWING THE NOTICE OF TAX
PLEASE TYPE OR PRINT
STEP 1
LAST NAME
FIRST NAME
PROPERTY
OWNER(S)
LAST NAME
FIRST NAME
STREET ADDRESS
ADDRESS (CONTINUED)
TOWN/CITY
STATE
ZIP CODE
PLEASE TYPE OR PRINT
STREET
STEP 2
PROPERTY
LOCATION
COUNTY
TOWN/CITY
NUMBER OF ACRES
MAP #
LOT #
BOOK #
PAGE #
STEP 3
(a) Tax year for which the deferral is requested
TO BE
(b) Amount of requested tax deferral
$
COM-
PLETED
(c)
Amount of Tax Bill
$
BY THE
Yes
No
(d) Tax year for which the deferral is requested
PROPERTY
Is age 65 or older, and has owned the homestead for 5 years, or
OWNER
Receives benefits under Title II or Title XVI of the Federal Social Security act and
has owned the homestead for one year.
And, is living in the home.
STEP 4
I understand that upon approval of this application, by the local assessing officials, a deferral shall be
PROP-
created against the previously described property, pursuant to RSA 72:38-a. My signature below
ERTY
indicates my agreement with the obligation incurred against the property described in Step 2 above.
OWN-
TYPE OR PRINT NAME (IN BLACK INK)
SIGNATURE (IN BLACK INK)
DATE
ERS
SIGNA-
TYPE OR PRINT NAME (IN BLACK INK)
SIGNATURE (IN BLACK INK)
DATE
TURES
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-30
Rev 3 / 6 / 13
Page 1 of 3

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