New Hampshire  
                                Department of                      PA-34                   *00PA342411862*
                   Revenue Administration                                                                           00PA342411862

                                                            INVENTORY OF PROPERTY TRANSFER
STEP 1 - PURCHASER(S)           Grantee                                 (use new primary mailing address)
                                                                                                                                           0SJHJOBM 
Entity Type - (Check One):      Individual                  Joint Partnership  Corporation Trust                    LLC Holding Company
                                                                                                                                           "NFOEFE
Last Name / Entity                                                             First Name

Last Name / Entity                                                             First Name

Last Name / Entity                                                             First Name

Street No.                      Street Name                                    Apt / Unit                               Phone Number 

City                                                              State       Zip Code + 4 (or Canadian Postal Code)
                                                                   
Email (optional)

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

Last Name / Entity                                                             First Name

Last Name / Entity                                                             First Name

Street No.                      Street Name                                    Apt / Unit                               Phone Number 

City                                                              State       Zip Code + 4 (or Canadian Postal Code)
                                                                   
Email (optional)

STEP 3 - REAL ESTATE
Municipality                                                County
 
Street No.                      Street Name (If applicable)                    Apt / Unit

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                     New Hampshire  
                       Department of                        PA-34                              *00PA342421862*
              Revenue Administration                                                                                   00PA342421862

                                               INVENTORY OF PROPERTY TRANSFER
STEP 3 - REAL ESTATE   (continued)
Tax Map                                        Block                                               Lot

Acreage
                                              Number of Parcels Purchased
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 0OF    
                      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

                      Warranty       Quitclaim              Mortgage            Sheriffs           Tax                   Foreclosure
Type of 
Transfer              Commissioner's                        Fiduciary           Probate            In Lieu of Foreclosure             5SBOTGFS PO %FBUI
(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?

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

         Furnishings                                                          Other

         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

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                         New Hampshire  
                          Department of   PA-34           *00PA342431862*
                  Revenue Administration                                             00PA342431862

                                         INVENTORY OF PROPERTY TRANSFER

STEP 6 - PREPARER
Entity

Last Name                                       First Name

Street No.                Street Name           Apt / Unit                           Phone Number 

City                                     State Zip Code + 4 (or Canadian Postal Code)
                                          
Email (optional)

     PA-34                                                                                        Page 3 of  
     7FSTJPO       0 /202 

                     New Hampshire  
                      Department of                     PA-34         *00PA342441862*
              Revenue Administration                                                                         00PA342441862

                                              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

Purchaser's Printed Name

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)

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