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2. According to RSA 540:1-b, effective January 1, 2011, owners of restricted property must file a statement with the town or city clerk of the municipality in which the property is located that provides the name, address, and telephone number of a person within the state who is authorized to accept service of process for legal proceedings.

    Please review applicable State law to determine if your property is defined as “restricted” property (RSA 540:1-a). If so, you are required to fill out this form and return to the Office of the Town Clerk along with a $15.00 filing fee. Please make checks payable to the Town of Londonderry.

4. Property Owner's information:

6. Name
7. Email Address
9. Address
11. City /Town*
12. State
13. Zip Code
15. Phone Number
19. List all applicable property addresses (street addresses) within the Town of Londonderry that have the same agent:

23. Agent within the State of New Hampshire to contact to accept service for addresses listed in section above:

25. Name
26. Email Address
28. Address
30. City
31. State
32. Zip Code
34. Phone Number
36. Is there a date of expiration for the Owner's agreement with the Agent?*

    1. Yes

    1. No
38. Date of expiration:*
    Date of expiration:
Leave This Blank:


40. 1. Receive an email copy of this form.
41. Email address

    This field is not part of the form submission.

42. Submit

* indicates a required field