Form Dp-65 - Credit Claim For Real Estate Transfer Tax Stamps

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FORM
NEW HAMPSHIRE DEPARTMENT OF REVENUE ADMINISTRATION
DP-65
CREDIT CLAIM FOR REAL ESTATE TRANSFER TAX STAMPS
Rev 809.06(a)
072
NAME:
REGISTER OF DEEDS
COUNTY:
AMOUNT OF CLAIM: $
Documentation on Errors or Voided Stamps:
1 DATE OF ISSUE:
2 NUMBER AND DENOMINATION OF STAMPS ISSUED:
3 NAME AND ADDRESS OF GRANTOR:
4 NAME AND ADDRESS OF GRANTEE:
5 BOOK AND PAGE NUMBER WHERE DEED IS RECORDED:
6 CIRCUMSTANCES UNDER WHICH ERRONEOUS ISSUE WAS MADE:
7 ENCLOSE A PHOTO COPY OF THE DOCUMENT PAGE UPON WHICH THE ERRONEOUS STAMP/INDICIA WAS AFFIXED.
8 SIGNATURE OF REGISTER OF DEEDS OR AUTHORIZED AGENT
DATE
WHERE TO FILE: This form should be attached to the DP-4 for the period in which the credit is being claimed.
WHEN TO FILE:
Pursuant to Rev 809.06(a), Form DP-65 Credit Claim for Real Estate Transfer Tax Stamps or indicia erroneously issued and placed
on a recorded document shall be fi led with the Department for erroneously issued tax stamps or indicia.
FOR DRA USE ONLY
DP-65
Rev. 7/2008

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