This document is an application form for exemption from property taxes for residential properties located in industrial or commercial zones in New Hampshire. It requests information such as the applicant's name and address, tax map number, and requires the applicant's signature certifying the information is true. It also provides instructions on who can file, where and when to file, appeal procedures if the application is denied, and contact information for help or for accessibility needs.

1. FORM NEW HAMPSHIRE DEPARTMENT OF REVENUE ADMINISTRATION
PA-42 RESIDENCE IN AN INDUSTRIAL OR COMMERCIAL ZONE
RSA 75:11
APPLICATION FOR EXEMPTION
NAME OF APPLICANT
NUMBER AND STREET/ROAD
CITY/TOWN, STATE & ZIP CODE
TAX MAP # BLOCK # LOT #
CITY/TOWN YEAR OF APPLICATION
I hereby certify that this information is true, correct and complete to the best of my belief and knowledge.
APPLICANTS SIGNATURE DATE
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
NOTICE TO APPLICANT FOR EXEMPTION
Notice is here by given that your application for an exemption on your residential property as described above has been:
GRANTED DENIED
Reason for denial:
Further information concerning this application may be obtained from the office of your local Selectmen/Assessors.
TYPE OR PRINT NAME SIGNATURE (in ink) DATE
TYPE OR PRINT NAME SIGNATURE (in ink) DATE
TYPE OR PRINT NAME SIGNATURE (in ink) DATE
TYPE OR PRINT NAME SIGNATURE (in ink) DATE
TYPE OR PRINT NAME SIGNATURE (in ink) DATE
Original to the Town
Copy to the Applicant
PA-42
Rev. 10/4/05

2. NEW HAMPSHIRE DEPARTMENT OF REVENUE ADMINISTRATION
FORM
PA-42 RESIDENCE IN AN INDUSTRIAL OR COMMERCIAL ZONE
RSA 75:11
The owner of record of any residence located in an industrial or commercial zone may apply on a form prepared by the selectmen
WHO MAY
or assessors for a special appraisal of the residence. After the initial application, reapplication may be made on a form which shall
FILE
be sent to the applicant by the assessing officials with the inventory blank.
WHERE TO The Form PA-42 must be submitted to the assessing officials in the municipality where the residence is located.
FILE
The Form PA-42 must be filed on or before April 15th of each year to the Selectmen or Assessors. If any owner shall satisfy the
WHEN TO
assessing officials that the owner was prevented by accident, mistake or misfortune from filing said application on or before April
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15th, the officials may receive the application at a later date and classify the residence under this section; but no such application
shall be received after the local tax rate has been approved by the Commissioner of Revenue Administration for that year.
APPEAL An appeal may be made if the assessing officials deny in whole or in part any application for classification as an eligible residence.
PROCEDURE The applicant, having complied with the requirements of RSA 75:11, I, may appeal on or before 30 days after such action. The appeal
must be in writing and accompanied by a $65 filing fee, apply to the Board of Tax and Land Appeals.
NEED HELP Please call Customer Service at (603) 271-2191, Monday through Friday, 8:00 am - 4:30 pm.
ADA Individuals who need auxiliary aids for effective communications in programs and services of the New Hampshire Department of
COMPLIANCE Revenue Administration are invited to make their needs and preferences known. Individuals with hearing or speech impairments may
call TDD Access: Relay NH 1-800-735-2964.
PA-42
Instructions
Rev. 10/4/05