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.
lf 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 itis submitted. If a contract is entered into, a copy
of this 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 *
Interest *
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
