Rsa 79-A:10 Land Use Change Tax Abatement Application To Municipality Page 4
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4SECTION I. Certification and Appearance by Representative
(If Other Than Owner(s)/Taxpayer(s))
By signing below, the representative of the person(s) applying certifies and swears under
penalties of RSA ch. 641:
1.
All (certifications) in Section H are true;
2.
The person(s) applying has authorized this representation and has signed this application;
and
3.
A copy of this form was provided to the person(s) applying.
Date:
(Signature)
SECTION J. Disposition of Application (For Selectmen's/Assessor's Use)
Abatement Request: DENIED _____ GRANTED _____ Revised Assessment $
Remarks:
Date:
(Selectman Signature)
(Selectm
an Signature)
(Selectman Signature)
(Selectm
an Signature)
(Selectman Signature)
(Selectm
an Signature)
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