DELINQUENT PERSONAL PROPERTY STATEMENT
, hereby affirms under oath, pursuant to New Hampshire State
Code, that at the time the bid was submitted by_(company) was / was not (please circle one) charged with
delinquent personal property taxes on the General Tax List of Personal Property for Hillsborough County, New
Hampshire.
If such charge for delinquent personal property tax exists on the General Tax List of Personal Property for
Hillsborough County, New Hampshire, the amount of such due and unpaid delinquent taxes, including due
and unpaid penalties and interest shall be set forth below. A copy of this statement shall be transmitted to
the Hillsborough County Treasurer within thirty (30) days of the date it is submitted. If a contract is entered
into, a copy ofthis statement shall also be incorporated into the contract between NTS and the bidder and no
payment shall be made with respect to any contract unless such statement has been so incorporated as a
part thereof.
Delinquent Personal Property Tax *
Company
Signed By
Name & Title
Date
State of
County of
SWORN TO BEFORE ME THIS DAY OF. ,20_.
NOTARY PUBLIC
SEAL
MY COMMISSION EXPIRES
* Mark “N/A’ if not applicable
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