Utility Property Tax List of Pollution Control Exemptions

This document is a New Hampshire Department of Revenue Administration form for listing pollution control exemptions. It requires the owner of a utility property to provide their name, federal employer identification number, and to list each New Hampshire Department of Environmental Services exempted pollution control item located in the state. For each item, the owner must identify the city/town location, the percentage exempted by DES, and the original cost. The owner or authorized representative must sign and date the completed form.