Btla A 9 Form PDF Details

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Form NameBtla A 9 Form
Form Length2 pages
Fillable fields0
Avg. time to fill out30 sec
Other namesbtla form a 9, organization rsa form, how to fill out a btla a 9, nh btla forms hardship

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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:



1.Name of applicant organization:


2.Mailing address and telephone number:

3.In what municipality is this exemption claimed?

4.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.)

5.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:



6.State general purpose for which applicant is organized or incorporated:

7.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?

8.If the applicant is a religious organization, is it a regularly recognized and constituted denomination, creed or sect? If so, give its generally recognized name

Form BTLA A-9


9.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.



Primary Use and its extent

or duration

Other Use and its extent

or duration


Tax Map


Primary Use and its extent

Other Use and its extent

& Lot No.


or duration

or duration


5 acres of land

Continual support of








Smith & Jones bldgs.







Smith house

25% science teacher’s apt








75% dormitory (18 students)

4-H for 6 wks.






Jones Bldg.

40% apt. rent to public








50% student assemble room

Rented to town 4-5 times/yr.







10% school nurse’s office







Brown lot-28 acres

Camping and hiking by scouts;








150/yr. for 2 wk. period