NEW HAMPSHIRE DEPARTMENT OF REVENUE ADMINISTRATION
FORM
ALTERNATE ASSESSMENT ELECTION FORM
PA-65
LOW INCOME HOUSING TAX CREDIT PROPERTIES
PROPERTY QUALIFIED UNDER RSA 75:1-a
THIS FORM MUST BE SUBMITTED TO THE MUNICIPALITY BY OCTOBER 1, 2008
Questions relating to this form may be directed to NH DRA, Property Appraisal Division, (603) 271-2191.
STEP 1 LAND USE RESTRICTION AGREEMENT (LURA)
LURA
INFORMATION Where Recorded (Municipality): Book/Page: Date:
Legal Owner of Property (Entity Name):
Name:
STEP 2
ENTER
Address:
OWNERSHIP
INFORMATION
City/State/Zip: Phone Number:
Email Address (optional): Fax Number:
ENTER CONTACT INFORMATION IF DIFFERENT THAN ABOVE
Name:
Address:
City/State/Zip: Phone Number:
Email Address (optional): Fax Number:
STEP 3 Municipality: Name of Project:
ENTER
PROPERTY Street Address:
INFORMATION
Tax Map/Lot Number(s):
No. of Buildings: No. of Apartments:
STEP 4 Signature below indicates election to require the municipality to assess the above-referenced property under RSA 75:1-a for
SIGNATURE the next ten years.
I hereby certify under penalties of perjury that the information provided above is correct and accurate to the best of my belief
and knowledge, and I am authorized to submit this form on behalf of the property owner named herein. Additionally, by
executing this election, I understand and acknowledge that there is a requirement to supply financial information and other
operating data annually by certain deadlines for the duration of the 10-year election period.
SIGNATURE DATE
PRINT SIGNATORY NAME & TITLE
PA-65
Rev. 9/2008