Form Pa-30 - Elderly And Disabled Tax Deferral Application Page 2

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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
STEP 5
NAME OF MORTGAGE HOLDER
APPROVAL
BY THE
SIGNATURE OF OFFICER OR AGENT FOR MORTGAGEE
TITLE
DATE
MORT-
GAGEE
By signing above, the mortgagee signifies that they do approve and are duly notified that upon approval of this
application by the local assessing officials a deferral shall be created against the above described property, pursuant
to RSA 72:38-a, III.
STEPS BELOW TO BE COMPLETED BY LOCAL ASSESSING
OFFICIALS
STEP 6
(a) Amount of taxes deferred in prior years
$
AMOUNT
OF TAXES
(b) Amount of taxes deferred in current year
$
DEFERRE
D
(c)
Total amount of taxes deferred [Step 6(a) plus Step 6(b)]
$
STEP 7
(a) Enter the percentage of total equity value of the property encumbered in Prior Years
%
PERCENT
OF EQUITY
(b) Enter the percentage of total equity value of the property encumbered in Current Year
%
VALUE
ENCUM-
(c)
Enter the percentage of total equity value of the property encumbered for All Years
%
BERE
D
STEP 8
TYPE OR PRINT NAME (IN BLACK INK)
SIGNATURE (IN BLACK INK)
DATE
APPROVAL
OF A
TYPE OR PRINT NAME (IN BLACK INK)
SIGNATURE (IN BLACK INK)
DATE
MAJORITY
OF
SELECT-
TYPE OR PRINT NAME (IN BLACK INK)
SIGNATURE (IN BLACK INK)
DATE
MEN/
ASSES-
TYPE OR PRINT NAME (IN BLACK INK)
SIGNATURE (IN BLACK INK)
DATE
SORS
DATE
TYPE OR PRINT NAME (IN BLACK INK)
SIGNATURE (IN BLACK INK)
PA-30
Page 2 of 3
Rev 3 / 6 / 13

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