Get NH BTLA A-9

Form BTLA A-9 Page 1 The State of New Hampshire List of Real Estate and Personal Property on which Exemption is Claimed Pursuant to RSA 72 23-c This form must be filled in and filed annually before April 15. The ORIGINAL list must be filed with the selectmen assessors of the town city in which such property is located* A DUPLICATE copy should be retained by the applicant. Failure to file this list may result in denial of the exemption* This is to certify that the answers to the following interrogatories are true and correct to the best of my knowledge and belief and that I am duly authorized to sign on behalf of the applicant organization* Signed by Date NAME TITLE Name of applicant organization OWNER OF PROPERTY OR PRINCIPAL OCCUPANT CIRCLE ONE OR BOTH Mailing address and telephone number In what municipality is this exemption claimed Under which section is applicant requesting exemption An organization may not claim multiple exemptions under separate provisions of RSA 72 23 RSA 72 23 III religious RSA 72 23 IV educational RSA72 23 V charitable Form A-12 must also be filed if applicant is requesting exemption as a charitable organization* Is the applicant organization organized or incorporated in New Hampshire Yes No Does it have a principal place of business in this state Yes No. If yes where ADDRESS State general purpose for which applicant is organized or incorporated TELEPHONE NUMBER If applicant is requesting exemption as a charitable organization under RSA 72 23 V a What service of public good or welfare is provided b Who are the beneficiaries of this service c Is there a charge for this service If yes explain d For what purpose is any income used If so give its generally recognized name Page2 State whether the applicant has been granted exemption from taxation by special act of legislature since May 7 1913. If so give date. 10. Did the municipality where the applicant claims exemption vote prior to April 1 1958 to grant exemption on property not specifically exempted by Chapter 72 RSA as amended by Chapter 202 of the Laws of 1957 If so what is the total amount of the exemption voted 11. List real estate and personal property on which exemption is claimed for this town city and the purpose of which each item is used* Itemize each building or tract of land separately indicating the approximate area or percentage used for exempt purposes. See example Tax Map Lot No* Property Description Primary Use and its extent or duration Other Use and its extent EXAMPLE 25/6 5 acres of land Continual support of Smith Jones bldgs. Smith house 25 science teacher s apt 75 dormitory 18 students Jones Bldg. 4-H for 6 wks. 40 apt. rent to public 50 student assemble room Rented to town 4-5 times/yr. 10 school nurse s office 35/2 Brown lot-28 acres Camping and hiking by scouts 150/yr. for 2 wk. period Logging. The ORIGINAL list must be filed with the selectmen assessors of the town city in which such property is located* A DUPLICATE copy should be retained by the applicant. Failure to file this list may result in denial of the exemption* This is to certify that the answers to the following interrogatories are true and correct to the best of my knowledge and belief and that I am duly authorized to sign on behalf of the applicant organization* Signed by Date NAME TITLE Name of applicant organization OWNER OF PROPERTY OR PRINCIPAL OCCUPANT CIRCLE ONE OR BOTH Mailing address and telephone number In what municipality is this exemption claimed Under which section is applicant requesting exemption An organization may not claim multiple exemptions under separate provisions of RSA 72 23 RSA 72 23 III religious RSA 72 23 IV educational RSA72 23 V charitable Form A-12 must also be filed if applicant is requesting exemption as a charitable organization* Is the applicant organization organized or incorporated in New Hampshire Yes No Does it have a principal place of business in this state Yes No. .