Print Form             Reset Form
                         New Hampshire  
                         Department of                     PA-34                    *00PA342311862*
                         Revenue Administration                                                        00PA342311862
                                                     INVENTORY OF PROPERTY TRANSFER
STEP 1 - PURCHASER(S)           Grantee                          (use new primary mailing address)

Entity Type - (Check One): Individual                Joint    Partnership Corporation Trust              LLC          Holding Company
Last Name / Entity                                                        First Name
DAY                                                                       MICHAEL
Last Name / Entity                                                        First Name

Last Name / Entity                                                        First Name

Street No.               Street Name                                      Apt / Unit                   Phone Number 
15                       WALLABEE WAY                                     2                            6 0 3 5      2 5 4  4     1 5
City                                                       State Zip Code + 4 (or Canadian Postal Code)
CONCORD                                                    NH    0 3 3 0 1 -        1 2 3 4
Email (optional)
TEST@TEST.COM

STEP 2 - SELLER(S)                      Grantor                  (use new primary mailing address)
Entity Type - (Check One): Individual                Joint    Partnership Corporation Trust              LLC          Holding Company

Last Name / Entity                                                        First Name
SMITH                                                                     JORDAN 
Last Name / Entity                                                        First Name

Last Name / Entity                                                        First Name

Street No.               Street Name                                      Apt / Unit                   Phone Number 
15                       HIGH ST                                          2                            6 0 3 6      5 2 6  6    5 5
City                                                       State Zip Code + 4 (or Canadian Postal Code)
CONCORD                                                    NH    0 3 3 0 1
Email (optional)

STEP 3 - REAL ESTATE
Municipality                                         County
CONCORD                                              MERRIMACK
Street No.               Street Name (If applicable)                      Apt / Unit
45                       LIBERTY LN 

     PA-34 
     Rev  1  .9 7 0 /2023                                                                                             Page 1 of 6

                         New Hampshire  
                             Department of                           PA-34                          *00PA342321862*
                         Revenue Administration                                                                             00PA342321862

                                                     INVENTORY OF PROPERTY TRANSFER
   STEP 3 - REAL ESTATE   (continued)
   Tax Map                                           Block                                              Lot
   6 5 2 4               1                            1 7                                               4
   Acreage
                                       2           Number of Parcels Purchased                  5
   Multi Town Sale?                  If Yes, list municipalities:
     Yes                 No
Property Use 
(Check One):               Residential     Commercial            Mixed Res / Comm    Industrial         Other

   Property Type           Land Only       Building Only         Land & Building     Condo              Condex                  Land & Manufactured Housing
   (Check One):  
                           Manufactured Housing                  Multi-unit          Timber Rights      Mineral Rights
   Features 
   (Check One):            Waterfront      Water Access          If multi-unit building, how many units?

   STEP 4 - DEED
   Transfer Date                       Recording Date                       Book No.                Page No.                  Sale Price
   0 9      0    5       2 0 2 3         0 9 0     7  2  0       2 3               1 8 5 5                              6 3                 $ 4   0     0 0  0            0
                           Warranty        Quitclaim             Mortgage            Sheriffs           Tax                     Foreclosure
   Type of 
   Transfer                Commissioner's                        Fiduciary           Probate            In Lieu of Foreclosure
   (Check one):
   STEP 5 - TRANSACTION DETAIL
                                                                                                                             If Yes, please choose all that apply from 
   Were there any special circumstances in the transfer which suggest that the full price               Yes             No   the list below or select “other” and fill in 
   or consideration of the property was either more or less than its fair market value?                                      an explanation.
            Family Sale             Sheriff's Sale       Business Affiliates         Bank Sale          Easement              Life Estate / Trust       Time Share

            Government Sale                              Abutter Sale                Other

     Did the sale transfer 100% interest in the property?            Yes         No      If no, what % interest transferred?                            5 0

   Did the sale price above include a consideration for non-taxable personal property?                  Yes             No If yes, indicate value below:

            Furnishings                            1 5   0       0                 Other                                3   0 0

             Inventory                                                           Timber

   Was the sale price reduced because of a Land Use Change Tax?                      Yes  No            If yes, by what 
                                                                                                        amount?
   Do you consider the selling price to be fair market value?               Yes      No  If no, 
                                                                                         explain
   Have you or will you make improvements to the property after the purchase but before April 1st?                      Yes   No
   If yes please indicate approximate cost of these improvements:

   Occupancy and status of structure               No Structure             New Construction (1 yr)     Previously Occupied

   Will the property serve as your primary residence?              Yes           No

     PA-34 
     Rev  1  .9 7 0 /2023                                                                                                                         Page 2 of 6

                         New Hampshire  
                         Department of          PA-34           *00PA342331862*
                         Revenue Administration                                             00PA342331862

                                        INVENTORY OF PROPERTY TRANSFER

STEP 6 - PREPARER
Entity
REAL ESTATE COMPANY 
Last Name                                             First Name
SELLING                                               SAVANNAH
Street No.               Street Name                  Apt / Unit                            Phone Number 
45                       MARKET ROAD                                                        6 0 3 5      6 2 2  2    6 6
City                                            State Zip Code + 4 (or Canadian Postal Code)
MANCHESTER                                      NH    0 3 1 0 4
Email (optional)
TEST@TEST.COM

     PA-34 
     Rev  1  .9 7 0 /2023                                                                                  Page 3 of 6

                    New Hampshire  
                      Department of                     PA-34         *00PA342341862*
                    Revenue Administration                                                                   00PA342341862

                                              INVENTORY OF PROPERTY TRANSFER 
                                                        SIGNATURE PAGE

STEP 7 - SIGNATURES
Power of Attorney (POA): By checking this box and signing below, you authorize the preparer listed on this document to act on your behalf for this 
document only, including entering the book and page numbers and filing this document electronically.
TAXPAYER'S SIGNATURE & INFORMATION (Purchaser's Signature is Required) 
Under penalties of perjury, I declare that I have examined this return and to the best of my belief it is true, correct and complete. 
Purchaser's Signature                                                                                MMDDYYYY
                                                                                                     1 0 1 0 2 0 2                    3
Purchaser's Printed Name
MICHAEL DAY

Purchaser 2 Signature                                                                                MMDDYYYY

Purchaser 2 Printed Name

Purchaser 3 Signature                                                                                MMDDYYYY

Purchaser 3 Printed Name

PREPARER'S SIGNATURE & INFORMATION (If prepared by someone other than the Purchaser) 
Under penalties of perjury, I declare that I have examined this document and to the best of my belief it is true, correct and complete. (If prepared by a person other 
than the taxpayer, this declaration is based on all information of which the preparer has knowledge.)
Preparer's Signature (if other than taxpayer)                                                        MMDDYYYY

Preparer's Printed Name (required if POA box is checked)

PA-34 
Rev  1  .9 7 0 /2023                                                                                                                   Page 4 of 6

                    New Hampshire  
                                                                                      General Questions 
                    Department of                         PA-34
                    Revenue Administration                                            Line-By-Line Instructions

DEAR PROPERTY OWNER:  
The Department of Revenue Administration is responsible for equalizing the value of property in each municipality.  Equalization is used to 
accurately apportion county and school district taxes among the cities and towns and to distribute state revenues to the cities and towns.  To 
equalize property values, the Department of Revenue Administration annually conducts a sales/assessment ratio study for each municipality.
The information provided on the PA-34 form is needed to assist the Department in determining whether a particular sale involved is an “arms-
length transaction” and should be included in our equalization sales/assessment study.  If you have questions regarding this form, please 
contact us at (603)230-5920. 

WHO MUST FILE 
The purchaser, grantee, assignee or transferee of each transfer of real estate or interest in real estate must file the PA-34 form.  There are no 
exceptions. 

WHEN TO FILE 
Form PA-34 is due no later than 30 days from the recording date of the deed at the register of deeds or the date of the transfer, whichever is 
later. 

WHERE TO FILE 
A PA-34 form must be filed with the Department of Revenue Administration, P.O. Box 1313 Concord, NH 03302-1313 via the U.S. Post Office or 
hand carried to the Department of Revenue Administration at 109 Pleasant Street, Concord, NH, between the hours of 8:00 a.m. and 4:30 p.m.
A copy of the PA-34 form must also be filed with the local assessing officials of the municipality in which the property is located. 

NEED HELP? 
Questions not covered here may be answered in our Frequently Asked Questions (FAQ) available on our website at www.revenue.nh.gov/ or by 
calling Taxpayer Services at (603) 230-5920, Monday through Friday, 8:00 am to 4:30 pm. All written correspondence to the Department should 
include the taxpayer name, taxpayer identification number, the name of a contact person and a daytime telephone number. Individuals who 
need auxiliary aids for effective communications in programs and services of the New Hampshire Department of 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. 

NEED FORMS? 
To access additional forms, please visit our web site at www.revenue.nh.gov/ or call the Forms Line at (603) 230-5001. 

LINE-BY-LINE INSTRUCTIONS 
Please PRINT legibly or type all information. 

STEP 1  - Purchaser(s) 
First select the applicable Entity Type of the purchaser. 
Enter the full name and address (use new primary mailing address) of the purchaser(s), grantee(s), assignee(s) or transferee(s).  Email address is 
an optional field.  Please attach an additional PA-34 for more than three purchasers. 

STEP 2  - Seller(s) 
First select the applicable Entity Type of the seller. 
Enter the full name and address (use new primary mailing address) of the seller(s), grantor(s), assignor(s) or transferor(s).  Email address is an 
optional field.   

STEP 3  - Real Estate 
        Property Location and Description: Enter the municipality, county, street number, street name, and apartment/unit number where 
         the property is located.  Provide the tax map, block and lot (parcel identification number) used by the municipality to identify the 
         parcel as well as the area in acres and the number of parcels purchased.  If the sale is a multi-town sale, please enter all of the 
         municipalities where parcels are located. Parcel identification numbers are available at local assessing office. 
        Property Use: Select the primary use of the parcel; only one option may be selected. 
        Property Type: Select the property type of the parcel; select all that apply. 
        Features: Identify if the parcel is waterfront or has water access, if applicable.  Only one option may be selected.  For multi-unit 
         buildings please indicate the number of units. 

STEP 4  - Deed 
Enter the transfer date, recording date and Book and Page numbers assigned by the County Register of Deeds, along with the sale price (actual 
amount paid).  Please indicate the deed type for the transactions, only one option may be selected.  Please note that Book and Page numbers 
are required and the form will be returned if these fields are left blank.
PA-34 
Rev  1  .9 7 0 /2023                                                                                                                 Page 5 of 6

                      New Hampshire  
                      Department of                  PA-34                              Line-By-Line Instructions
                      Revenue Administration

STEP 5  - Transaction Detail 
• Question 1: Check the appropriate box as to whether there were any special circumstances that would suggest the full price or 
  consideration of the property was either more or less than its fair market value.  If “yes,” please choose all reasons that apply or select “other” 
  and provide a detailed explanation. 

• Question 2: Check the appropriate box as to whether the sale transferred 100% interest in the property.  If “no,” indicate the percentage of
  interest in the property that was transferred. 

• Question 3: Check the appropriate box as to whether the sale price included a consideration for non-taxable personal property.  If “yes,” 
  indicate the approximate value of furnishings, inventory, timber and/or other property (appliances, minerals, boats, equipment, inventory of 
  a business, etc.) in the appropriate box. 

• Question 4: Check the appropriate box as to whether the sale price was reduced because of a Land Use Change Tax per RSA 79-A:7. If “yes,”
  please specify the amount. 

• Question 5: Check the appropriate box as to whether you consider the selling price to be fair market value.  If “no,” please explain the
  reason(s) why. 

• Question 6: Check the appropriate box as to whether the grantee has made or intends to make improvements to the property after the 
  purchase but before April 1st.  If “yes,” please indicate the approximate cost of these improvements.  Do not include improvements made by 
  the grantor prior to establishing the sale price. 

• Question 7: Check the appropriate box as to the occupancy and status of the structure. 

• Question 8: Check the appropriate box as to whether the property will serve as your primary residence. 

STEP 6  - Preparer 
If this form was filled out by someone other than the purchser, please enter the full name, entity, address, identification number, phone 
number and email address (optional) of the preparer. 

STEP 7  - Signatures (Paper Form) 
• Power of Attorney (POA): By checking the POA box, and signing below, the taxpayer(s) authorizes the preparer listed in Step 6 to act on your
  behalf for this document only, including entering the Book and Page numbers and filing this document.  This is a limited POA for this 
  document only.  If a Purchaser does not authorize the POA then a separate PA-34 must be filed. 

• Purchaser's Signature and Information:  The Form must be signed in ink and dated by the Purchaser(s). 

• Preparer's Signature and Information: If the Form was prepared by someone other than the Purchaser(s), the Form must be dated and signed
  in ink by the preparer.  The preparer's printed name is also required if the POA box is checked. 

  PA-34 
  Rev  1  .9 7 0 /2023                                                                                                          Page 6 of 6