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Get NH BTLA A-12 2007-2024

Form BTLA A-12 The State of New Hampshire CHARITABLE ORGANIZATION FINANCIAL STATEMENT Pursuant to RSA 72 23 VI every charitable organization or society must file a statement of its financial condition with the municipality in which the property is located. This statement is due annually before June 1. In compliance with this statute please complete and return this form with attachments if necessary to the municipality. For Fiscal Year to 1. In what municipality is this exemption claimed 2. Name of Organization or Society 3. Name s and Address es of the Principal Officers 4. Internal Revenue Service Identification Number 5. Date of Registration or Incorporation with the N*H. Secretary of State 6. Attach financial statement or best evidence available of the organization s source of income and expenditures in the preceding fiscal year. 7. If the organization or society files INTERNAL REVENUE SERVICE FORM 990 or other similar non-profit informational return please enclose a copy. Signature Treasurer or Principal Officer Send Original form and accompanying information to local assessing officials. In compliance with this statute please complete and return this form with attachments if necessary to the municipality. For Fiscal Year to 1. In what municipality is this exemption claimed 2. Name of Organization or Society 3. For Fiscal Year to 1. In what municipality is this exemption claimed 2. Name of Organization or Society 3. Name s and Address es of the Principal Officers 4. Internal Revenue Service Identification Number 5. Name s and Address es of the Principal Officers 4. Internal Revenue Service Identification Number 5. Date of Registration or Incorporation with the N*H. Secretary of State 6. Attach financial statement or best evidence available of the organization s source of income and expenditures in the preceding fiscal year. Date of Registration or Incorporation with the N*H. Secretary of State 6. Attach financial statement or best evidence available of the organization s source of income and expenditures in the preceding fiscal year. 7. If the organization or society files INTERNAL REVENUE SERVICE FORM 990 or other similar non-profit informational return please enclose a copy. 7. If the organization or society files INTERNAL REVENUE SERVICE FORM 990 or other similar non-profit informational return please enclose a copy. Signature Treasurer or Principal Officer Send Original form and accompanying information to local assessing officials. In compliance with this statute please complete and return this form with attachments if necessary to the municipality. For Fiscal Year to 1. In what municipality is this exemption claimed 2. Name of Organization or Society 3. Name s and Address es of the Principal Officers 4. Internal Revenue Service Identification Number 5. For Fiscal Year to 1. In what municipality is this exemption claimed 2. Name of Organization or Society 3. Name s and Address es of the Principal Officers 4. Internal Revenue Service Identification Number 5. Date of Registration or Incorporation with the N*H. Secretary of State 6. Attach financial statement or best evidence available of the organization s source of income and expenditures in the preceding fiscal year. .

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