FORM
NEW HAMPSHIRE DEPARTMENT OF REVENUE ADMINISTRATION
CU-12
SUMMARY OF FOREST STEWARDSHIP PLAN
Print and Reset Form
FOR CURRENT USE ASSESSMENT
This form is NOT required if either of the following is provided to the Selectmen/Assessing officials:
A
Documentation of a Certified Tree Farm, or a copy of the letter from the New Hampshire Tree Farm Committee confirming Certified Tree Farm
status; OR
B
A Forest Stewardship Plan that meets the requirements of CUB 304.09(a)(3)(b).
PLEASE PRINT OR TYPE
NAME OF APPLICANT
ADDRESS
CITY/TOWN, STATE, ZIP CODE
1
Land located in the City/Town of:
2
Street location of the land being classified:
3
Local tax map and lot number(s) of the land being classified:
4
Total number of acres in parcel:
Total number of acres receiving current use assessment:
5
Total number of acres to be classified under the "Forestland with Documented Stewardship" category:
6
Attach a statement of past forestry accomplishments, including an explanation of deviations from the objectives of past plans submitted.
An updated map is required of the entire parcel(s) adequately identified and oriented to establish its location. Besides showing overall boundaries
7
and computation of acreages, the map shall show interior boundaries and acreages of land categories for which the applicant is seeking
qualification. Differentiating land uses within each category and all portions of the parcel(s) not bearing current use shall be clearly identified and
the appropriate acreages shown.
Attach a summary of all information required by CUB 304.09(a)(3)(b). See the back of this form for requirements.
8
I/We certify that the land indicated above qualifies for Current Use assessment under the New Hampshire statutes RSA 79-A and the Code of
Administrative Rules, CUB 300.
I/We understand that, should the use of the above described land be changed to a non-qualifying use, that the owner of record at the time of the
change in use shall be liable for the Land Use Change Tax pursuant to RSA 79-A and the Criteria for Current Use, CUB 300.
LAND OWNER'S SIGNATURE(S)
FORESTER'S SIGNATURE
DATE
DATE
Forester's License Number
DATE
DATE
SELECTMEN'S SIGNATURES
APPROVED
DENIED
DATE:
DATE:
DATE:
DATE:
DATE:
Reason for Denial
CU-12
Rev. 3/2013