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FORM

DP-10

041

NEW HAMPSHIRE DEPARTMENT OF REVENUE ADMINISTRATION

INTEREST AND DIVIDENDS TAX RETURN

For the CALENDAR year 1999 or other tax year beginning

and ending

FOR DRA USE ONLY

Day

Year

Mo Day

Year

Due Date for CALENDAR year is on or before April 18, 2000 or the 15th day of the 4th month after the close of the fiscal period.

STEP 1

LAST NAME

FIRST NAME & INITIAL

SSN

Please Print

SPOUSE’S LAST NAME

FIRST NAME & INITIAL

or Type

SPOUSE’S SSN

NUMBER AND STREET ADDRESS

FEIN

(Partnership or Fiduciary)

CITY OR TOWN, STATE AND ZIP CODE

STEP 2

1 INDIVIDUAL OR

1 JOINT

PARTNERSHIP

4 FIDUCIARY

% of NH Ownership

Entity Type

Check here if you would like your forms mailed to an address other than the above. (See instructions)

and Mailing

Information

Number and Street Address

City/Town

State

Zip

STEP 3

INITIAL RETURN: Date established residency

Special

Day

Year

Return Type

.............................................................................................FINAL RETURN: Date abandoned residency

Day

Year

FINAL RETURN: Deceased taxpayer: Social Security #

Date of death

Day

Year

AMENDED RETURN: DO NOT use this form to report an IRS adjustment . See instructions.

STEP 4

COMPLETE NUMBERS 1 - 5 ON PAGE 2 BEFORE COMPUTING TAX

STEP 5

Gross Taxable Income (Page 2, line 5)

Figure Your

Less: $2,400 Individual, Partnership, and Fiduciary; $4,800 Joint

Net Taxable

Adjusted Taxable Income (Line 6 less line 7)

Income

For Individual/Joint filers only: If line 8 is zero or less, you are not required to file.

However, to be removed from our mailing list check here and mail in the return

Deduction for Contribution to Qualified Investment Capital Company (see instructions)

Check the exemptions that apply

Blind

Spouse Blind

65 (or over) ____________ or disabled

Spouse 65 (or over) ____________ or disabled

Year of Birth

Total number of boxes checked ___________________ x $1,200= __________________

Net Taxable Income (Line 8 less lines 9 and 10)

STEP 6

New Hampshire Interest and Dividends Tax (Line 11 x 5%)

Figure Your

Payments: (a) Tax paid with Application for Extension

13(a)

Tax, Credits,

Interest and

(b) Payment from 1999 Declaration of Estimated Tax ...

13(b)

Penalties

13(c)

.....(d) Paid with original return (Amended returns only)

Balance of Tax Due (Line 12 less line 13)

Additions to Tax: (a) Interest (See instructions)

.....................................................

15(a)

(b) Failure to Pay (See instructions)

15(b)

15(c)

(d) Underpayment of Estimated Tax (See instructions) 15(d)

STEP 7

Total Balance Due (Line 14 plus line 15) Make check payable to: State of New Hampshire

Balance

Enclose, but do not staple or tape, your payment with this return.

OVERPAYMENT (Line 13 less line 12 adjusted by line 15, if applicable)17

Due or

Overpayment

Amount of line 17 to be applied to:

(a) Your 2000 tax liability

..........

18(a)

(b) Refund - Please allow 12 weeks for processing

18(b)

FOR DRA USE ONLY

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.

If prepared by a person other than the taxpayer, this declaration is based on all information of which the preparer has knowledge.

Signature

Date

Signature of Paid Preparer Other Than Taxpayer

If joint return, BOTH husband and wife must sign, even if only one had income. Date

Preparer’s Identification Number

Date

NH DEPT OF REVENUE ADMINISTRATION

MAIL

Preparer’s Address

DOCUMENT PROCESSING DIVISION

TO:

PO BOX 2072

CONCORD NH 03302-2072

City or Town, State, and Zip Code

DP-10

(1)

Rev. 12/99

(See instructions)

FORM

DP-10

NEW HAMPSHIRE DEPARTMENT OF REVENUE ADMINISTRATION

REPORT OF INTEREST AND DIVIDENDS INCOME

TAX YEAR 1999

1From Your Federal 1040 Income Tax Return: (Partnerships and Fiduciaries, see Instructions)

(a)	Interest Income.	Enter the amount from line 8(a)	1(a)
(b)	Dividend Income.	Enter the amount from line 9	1(b)
(c)	Federal Tax Exempt Interest Income. Enter the amount from line 8(b)		1(c)

2List Payments From S-Corporations, Partnerships, and Fiduciaries: See instructions Entity codes: 2=”S” or other Corporations; 3=Partnerships; 4=Trusts or Estates; 5=Other

(A)

ENTITY CODE

(B)

NAME OF

PAYER

(C)

PAYER’S IDENTIFICATION

NUMBER

(D)

DISTRIBUTION

AMOUNT

	Total from supplemental schedule attached
2	Total Distributions	2
3	Subtotal Sum of lines 1(a), 1(b), 1(c) and 2	3

4 List payers and amounts of interest and/or dividends NOT TAXABLE to NH included on lines 1(a), 1(b), 1(c), and/or 2:

(A)

REASON

CODE

(B)

NAME OF

PAYER

(C)

PAYER’S IDENTIFICATION

NUMBER

(D)

NON-TAXABLE

AMOUNT

	Total from supplemental schedule attached
4	Total Non-Taxable Amount	4
5	Gross Taxable Income(Line 3 minus line 4).ENTER THIS AMOUNT ON PAGE 1, LINE 6	5

(2)	DP-10
	Rev. 12/99

	DP-10	INTEREST AND DIVIDENDS TAX	1999
	FORM	NEW HAMPSHIRE DEPARTMENT OF REVENUE ADMINISTRATION
		INSTRUCTIONS
Instructions		INSTRUCTIONS

COMMON TAXPAYER ERRORS

The following is a list of the most common mistakes made by taxpayers when filing a NH Interest and Dividends Tax return. These, along with other errors, may cause the return to be considered an “incomplete return” which may result in the assessment of interest and penalties. To ensure that you have filed a complete return, carefully follow the general and line-by-line instructions and be sure you have done the following:

HAVE YOU SIGNED AND DATED THE RETURN?

IF THIS IS A JOINT RETURN, HAS YOUR SPOUSE INCLUDED THEIR SOCIAL SECURITY NUMBER, SIGNED AND DATED THE RETURN?

IF THERE IS A BALANCE DUE OF $1.00 OR GREATER, HAVE YOU ENCLOSED A CHECK FOR THE TOTAL AMOUNT DUE?

DID YOU MAKE THE CHECK PAYABLE TO THE STATE OF NEW HAMPSHIRE?

ARE THE WRITTEN AND NUMERIC AMOUNTS ON THE CHECK FOR THE SAME AMOUNT?

HAVE YOU SIGNED AND DATED THE CHECK?

HAVE YOU ENCLOSED BOTH PAGE 1 & 2 OF THE DP-10 AND KEPT A COPY OF BOTH PAGES FOR YOUR RECORDS?

If you have any questions regarding the Interest and Dividends Tax return, please call the Taxpayer Assistance Office at (603) 271- 2186. Hearing or speech impaired individuals may call TDD Access: Relay NH 1-800-735-2964.

		GENERAL INSTRUCTIONS

WHO	INDIVIDUALS: Individuals who are residents or inhabitants of the state for any part of the tax year must file
MUST	providing they received more than $2,400 of taxable interest and/or dividend income for a single individual or
FILE A	$4,800 of such income for a married couple filing a joint New Hampshire return.(Part-year residents see below.)
RETURN	To determine whether a return must be filed, you should complete either:
	(a) pages 1 and 2 of the return up to line 8, or
	(b) the following worksheet:
	INCOME:
	1(a) Total interest income		1(a)
	1(a) Total interest income		1(a)
	1(b) Total dividend income		1(b)
	1(b) Total dividend income		1(b)
	1(c) Total federal tax exempt interest income		1(c)
	1(c) Total federal tax exempt interest income		1(c)
	1(d) Total income received			1(d)
	DEDUCTIONS:
	2(a) Interest from direct U.S. Obligations		2(a)
	2(a) Interest from direct U.S. Obligations		2(a)
	2(b) Other non-taxable interest or dividend income (see Quick Checklist)		2(b)
			2(b)
	2(c)	Total deductions		2(c)
	2(c)	Total deductions		2(c)
	EXEMPTIONS:
	3	$2,400 if single, $4,800 if married	3
		(Part-year residents are entitled to full exemption)
		For purposes of this worksheet, the elderly and disabled exemptions do not apply to the calculation.
	TAXABLE INCOME:
	4 Subtract lines 2(c) and 3 from line 1(d) to arrive at taxable income		4
			4
	If the amount on line 4 is $0 or less you are not required to file an Interest and Dividends Tax Return. Please
	ONLY complete Step 1 of the return, check off “NOT REQUIRED TO FILE” (under line 8) and mail the form so
	that we may remove you from our mailing list.
	PARTNERSHIPS, ASSOCIATIONS, TRUSTS AND FIDUCIARIES: Please see separate instructions on page
	(5).
JOINT
FILERS	To ensure your payments are credited to your account, the sequence of names and social security numbers must
	be consistent on all Interest and Dividends Tax estimates, extensions and returns.
PART
YEAR	For New Hampshire Interest & Dividends Tax purposes, a “part year resident” is someone who has permanently
RESIDENCY	established residency in New Hampshire during the year or who has permanently abandoned residency in New
RESIDENCY	Hampshire during the year.
	Hampshire during the year.
	If you established residency after January 1, 1999, check the “Initial Return” box and enter the date of residency

	DP-10
(1)	Instructions
(1)	Rev. 12/99

	FORM	NEW HAMPSHIRE DEPARTMENT OF REVENUE ADMINISTRATION
	DP-10	NEW HAMPSHIRE DEPARTMENT OF REVENUE ADMINISTRATION
	DP-10	INTEREST AND DIVIDENDS TAX
Instructions		INTEREST AND DIVIDENDS TAX
Instructions			INSTRUCTIONS (continued)

	PART YEAR	A temporary absence for any length of time does not change your state of residency. If you are unsure whether
	PART YEAR	you are a resident of New Hampshire, please call the Taxpayer Assistance Office (603) 271-2186, Monday
	RESIDENT
	RESIDENT	through Friday, 8:00 a.m. to 4:00 p.m.
		through Friday, 8:00 a.m. to 4:00 p.m.
	(Continued)	Part-year residents are entitled to the full $2,400 exemption (or $4,800 for joint filers) and the full amount for the
		exemptions shown in step 5, line 10 of the return.
		Part-year residents must	file a return if, during the entire year, their taxable income was over $2,400 (or over
		$4,800 for joint filers). However, only the interest and dividends earned during that portion of the year for which
		they were a New Hampshire resident are taxable.

	WHEN	Calendar Year: If your return is based on a calendar year, it must be postmarked on or before April 18, 2000.
	WHEN	Fiscal Year: If your return is based on a tax year other than a calendar year, it must be postmarked on or before
	TO FILE
	TO FILE	the 15th day of the fourth month following the end of your tax year.


	WHERE		NH DEPT OF REVENUE ADMINISTRATION
	WHERE	MAIL	DOCUMENT PROCESSING DIVISION
	TO FILE	MAIL	DOCUMENT PROCESSING DIVISION
	TO FILE	TO:	PO BOX 2072
		TO:	CONCORD, NH 03302-2072
			CONCORD, NH 03302-2072
			FAX DOCUMENTS ARE NOT ACCEPTED

	NEED	Call the Taxpayer Assistance Office at (603) 271-2186, Monday through Friday, 8:00 am to 4:00 pm. If you need
	HELP	additional forms, please call our forms line at (603) 271-2192. Hearing or speech impaired individuals may call
	HELP	TDD Access: Relay NH 1-800-735-2964. Copies of forms are also available from many public libraries located
	OR FORMS
	OR FORMS	througout the state or over the internet at www.state.nh.us/revenue/revenue.htm.

EXTENSION		New Hampshire no longer requires taxpayers to file an application for an automatic 7-month extension of time to
TO		file provided that the taxpayer has paid 100% of the Interest and Dividends Tax determined to be due by the due
TO		date of the tax.
FILE		date of the tax.
FILE		If you need to make an additional payment, you must file a Form DP-59-A along with the payment. This
		application and payment must be postmarked on or before the due date of the return. Failure to pay 100% of the
		tax due by the original due date may result in the assessment of penalties.
		You are not required to attach a copy of your federal extension to your return.

	CONFIDENTIAL	Tax information which is disclosed to the New Hampshire Department of Revenue Administration is held in strict
	INFORMATION	confidence by law. The information may be disclosed to the United State Internal Revenue Service, agencies
	INFORMATION	responsible for the administration of taxes in other states in accordance with compacts for the exchange of

		information, and as otherwise authorized by New Hampshire Revised Statutes Annotated 21-J:14.

	SOCIAL	Disclosure of Social Security Account Numbers is mandatory under Department of Revenue Administration rules
	SECURITY	203.01, 221.02, 221.03, and 906.03(c). This information is required for the purpose of administering the tax laws
	SECURITY	of this state and authorized by 42 U.S.C.S. § 405 (c)(2)(C)(i).
	ACCOUNT
	ACCOUNT	The failure to provide Social Security Account Numbers may result in a rejection of a return or application. The
	NUMBERS	failure to timely file a return or application complete with Social Security Account Numbers may result in the
		imposition of civil or criminal penalties, the disallowance of claimed exemptions, exclusions, credits, deductions
		or adjustments that may result in increased tax liability.

AMENDED		If you discover an error was made on your return after it has been filed, an amended New Hampshire return
RETURNS		should be promptly filed by completing a corrected Form DP-10 and by checking the “AMENDED” box in Step 3
		on the return. New Hampshire does not have a separate form for amended returns. Changes made by the IRS
		must be reported under separate cover on Form RAR DP-10. Forms may be obtained by contacting the forms
		line at (603) 271-2192. You may contact the department at (603) 271-2186 with any questions.

	ROUNDING	Money items on all Interest and Dividends Tax forms may be rounded off to the nearest whole dollar.
	OFF
			LINE-BY-LINE INSTRUCTIONS

STEP 1		If you have received a booklet of tax forms and instructions type or print the name and address in the space
		provided. Individual/Joint returns must include social security number and, if applicable, spouse’s social security
		number in the space provided. For partnership or fiduciary returns, enter the federal identification number in the
		space provided.

STEP 2		Entity type. You must check only one box. If a partnership return, enter the percentage of ownership by New
		Hampshire residents. If a fiduciary return, enter the percentage of NH beneficiaries.
		Forms mailing information: If you will not be at your New Hampshire mailing address when the forms are mailed
		on approximately January 2nd and if you would like forms mailed to a winter address, please check the box and
		provide the address. This address will be used for form mailing purposes only.

	DP-10
(2)	Instructions
(2)	Rev. 12/99

	FORM		NEW HAMPSHIRE DEPARTMENT OF REVENUE ADMINISTRATION
	DP-10		NEW HAMPSHIRE DEPARTMENT OF REVENUE ADMINISTRATION
	DP-10		INTEREST AND DIVIDENDS TAX
Instructions			INTEREST AND DIVIDENDS TAX
Instructions			INSTRUCTIONS (continued)
			INSTRUCTIONS (continued)

STEP 3			Check the appropriate box, if any, of the questions which apply to this return and enter the information requested.

STEP 4			Complete PAGE 2 of the return. See PAGE 2 Instructions.

STEP 5			To figure your net taxable income, complete lines 6 through 11. For Individual /Joint filers ONLY, if line 8 is zero, you are not
			required to file a return. Please check the box under line 8 and submit the return so that we can remove you from our mailing
			list. If your filing requirements change, please contact the Department of Revenue Administration at (603)271-2186.
			Line 9: Deduct here the amount of any cash contribution made during the taxable period to a qualified investment capital
			company as defined in RSA 77-A:1,XXIV. (The return of any such contributions received within the next three subsequent
			periods is taxable and should subsequently be included in Line 2.)

STEP 6			Figure your Interest & Dividends Tax by multiplying line 11 by 5%. Enter the tax on line 12.
			Calculate the tax due by subtracting your payments (line 13a through 13d) from the tax you calculated (line 12).
			Enter the remainder, balance of tax due, on line 14.
			Figure your penalties, if any, as follows:
			(a) Interest is calculated on the balance of tax due (line 14) from the original due date to the date paid at the
			rate listed below. (Interest due = tax due x number of days x .000274).
			NOTE: The interest rate is recomputed each year under the provisions of RSA 21-J:28,II. Applicable rates for the
			current and prior years are as follows:

			PERIOD	RATE	DAILY RATE DECIMAL EQUIVALENT
			1/1/2000 - 12/31/2000	10%	.000274
			1/1/1999 - 12/31/1999	10%	.000274
			1/1/1998 - 12/31/1998	11%	.000301
			Prior to 1/1/1998	15%	.000411
			(b) A penalty equal to 10% of any nonpayment or underpayment of taxes may be imposed if the taxpayer fails
			to pay when the tax is due.
			(c) The late filing penalty is 5% of the tax due (line 14) for each month or part thereof for which the return is filed
			eyond the due date. The total amount shall not exceed 25% of the tax due. Calculate this penalty starting
			from the original due date of the return until the date a complete return has been filed.
			(d) If line 12 is more than $200 you may have been required to file estimated payments during the tax year. To
			calculate your penalty for nonpayment or underpayment of estimates or to determine if you qualified for an
			exemption from filing estimate payments, complete Form DP 2210/2220 which may be obtained by calling
		(603) 271-2192.
			Enter the total of lines 15(a) through 15(d) on line 15.
			Note:Taxpayers who substantially understate their tax on line 14 may be assessed a penalty by the Department in the
			amount of 25% of any underpayment of the tax resulting from such understatement. A substantial understatement is one
			which exceeds the greater of 10% of the amount of tax (line 14) or $5,000.

STEP 7			If your Interest & Dividends tax (line 12) plus interest and penalties (line 15) is greater than your payments (line 13),
			then enter on line 16 your balance of tax due. If less than $1.00, do not pay but still file the return. Make check or
			money order payable to: State of New Hampshire. Payment must		accompany the return; HOWEVER, PLEASE
			ENCLOSE, BUT DO NOT STAPLE	OR TAPE, YOUR PAYMENT WITH THE RETURN. To ensure your check is
			credited to your account, please put your social security or federal identification number on the check.
			If your total tax (line 12) plus interest and penalties (line 15) is less than your payments (line 13), then you have
			overpaid. Enter the overpayment amount on line 17.
			The taxpayer has an option of applying any part of the overpayment or the total amount of the overpayment as a
			credit on next year’s return. Enter the desired credit on line 18(a). The remainder, which will be refunded, should be
			entered on line 18(b). If line 18(a) is not completed, the entire overpayment will be refunded. Please allow up to 12
			weeks for the Department to process the refund.
			You MUST SIGN AND DATE your return. If you are filing a joint return, both husband and wife must sign and date the return
			even if only one of you had income. If you paid a preparer to complete this return, then the preparer must also sign and date
			the return. The preparer must also provide their federal identification number, social security number or federal preparer tax
			identification number and complete address.

			PAGE 2 INSTRUCTIONS

PRO-RATED			Individuals filing as part-year residents must include only the amount of taxable income earned during the period of
INTEREST &			New Hampshire residency. For your convenience you may prorate interest and dividends earned during the year
DIVIDENDS			based on the number of days you were a New Hampshire resident, divided by 365, multiplied by the amount of the
DIVIDENDS			income. Indicate the non-taxable amount on line 4.
			income. Indicate the non-taxable amount on line 4.

					DP-10
				(3)	Instructions
				(3)	Rev. 12/99
					Rev. 12/99

	FORM	NEW HAMPSHIRE DEPARTMENT OF REVENUE ADMINISTRATION
	DP-10	NEW HAMPSHIRE DEPARTMENT OF REVENUE ADMINISTRATION
	DP-10	INTEREST AND DIVIDENDS TAX

Instructions
Instructions		INSTRUCTIONS (continued)
		INSTRUCTIONS (continued)

LINE 1 LINE 1(a) INTEREST INCOME: Enter on line 1(a) ALL interest income. For individual and joint filers the amount to be reported on line 1(a) is from line 8(a) of IRS Form 1040 or 1040A. For partnerships and fiduciary filers, the amount to be reported on line 1(a) is the total of all interest income reported on your federal return. NOTE: All interest income which is not taxable to NH will be deducted on line 4.

LINE 1(b) DIVIDEND INCOME: Enter on line 1(b) ALL ordinary dividend income. For individual and joint filers the amount

to be reported on line 1(b) is from line 9 of IRS Form 1040 or 1040A. NOTE: All dividend income which is not taxable to NH will be deducted on line 4.

LINE 1(c) FEDERAL TAX-EXEMPT INTEREST INCOME: Enter on line 1(c) the amount of ALL federally tax-exempt interest income. For individuals and joint filers, the amount is from IRS Form 1040 or 1040A, line 8 (b). Unless specifically exempt by New Hampshire law, all federally tax-exempt interest income is taxable to New Hampshire. NOTE: All federal tax-exempt interest income that is not taxable to NH will be deducted on line 4.

LINE 2 OTHER INCOME SUBJECT TO THE NH INTEREST AND DIVIDENDS TAX: List on line 2 the payments you received or constructively received from S corporations, a partnership with transferable shares, a trust or estate with transferable shares, or the return of capital from a qualified investment capital company when the investment is returned within three years of the original deduction. These payments are subject to tax in NH as a “dividend”. (Transferable means that you can freely transfer your shares without causing a dissolution of the organization or without prior approval of the other members.) All publicly traded partnerships fall in this category. The payment you received or constructively received during the year may or may not correspond to the information shown on your Schedule K-1. Flow-through interest and dividend income from these organizations should be backed out on line 4. All other deductions also apply (e.g.capital gains, direct US government obligation, etc.) ALL NONTAXABLE INCOME WILL BE DEDUCTED ON LINE 4.

Line 2: In column A, enter the number which represents the type of entity of the payer. See the box below for ENTITY TYPE CODES. In column B, enter the name of the payer. In column C, enter the payer’s identification number, if known. In column D, enter the total amount of income (cash, property, etc.) received or constructively received. The column D amount is the total amount you received or constructively received from the payer during the year and may not correspond to any line on your IRS Form 1040 or your IRS Schedule K-1. NOTE: This is not a tax on pass-through losses or gains from a Schedule K-1. Therefore, do not add any pass-through losses or gains from Schedule K-1.

Entity Code

Entity Type

S Corporations

Partnerships

Trusts or Estates

Other

Other Corporations

LINE 3 Enter on line 3 the sum of lines 1(a), 1 (b), 1(c), and 2.

LINE 4 INTEREST AND DIVIDENDS INCOME NOT TAXABLE TO NH: In column A, enter the code number which corresponds

to the reason the income is not subject to the Interest and Dividends Tax.

(See the box below for reason codes.) In

column B, enter the name of the payer. In column C, enter the payer’s identification number, if known. In column D enter

the non-taxable amount.

REASON

CODE

Direct US Government Obligations

NH Municipal bond Interest

Long or short term capital gains included in line 3

Individual retirement account/Keogh plans/Other exempt retirement plans

Liquidating distributions

The partnership/trust is subject to the NH Interest & Dividends Tax

Interest or dividend income from a partnership/trust with non-transferable shares included in line 1(a) or 1(b)

Allocation to non-NH residents

Other (attach explanation) Flow through interest from Sch K-1

LINE 5

GROSS TAXABLE INCOME: Enter the amount of line 3 minus line 4.

Enter this amount on page 1, line 6.

	DP-10
	Instructions
(4)	Rev. 12/99
(4)

	FORM	NEW HAMPSHIRE DEPARTMENT OF REVENUE ADMINISTRATION
	DP-10	NEW HAMPSHIRE DEPARTMENT OF REVENUE ADMINISTRATION
	DP-10		INTEREST AND DIVIDENDS TAX
Instructions			INTEREST AND DIVIDENDS TAX
Instructions			INSTRUCTIONS (continued)
			INSTRUCTIONS (continued)

			PARTNERSHIP, TRUST, OR ESTATE INCOME

WHEN THE PAYER FILES ITS OWN NH INTEREST AND DIVIDENDS TAX RETURN:

Income from this payer is not taxable to you. The amount of interest and dividend income, if any, which is included in lines 1(a) and 1(b) and which shows on your IRS Schedule K-1 is not taxable to NH and should be deducted on line 4. Also enter on line 4 the amount, if any, that you listed on line 2.

“S” CORPORATION INCOME

Distributions from S Corporations are taxable to you. The entire amount you received or constructively received from the “S” corporation is subject to tax and should be listed on line 2. The amount of interest and dividend income, if any, which is included in lines 1(a) and 1(b) and which shows on your IRS K-1 Form is not taxable to NH and should be deducted on line 4.

		INSTRUCTIONS FOR COMPLETING A PARTNERSHIP,
		ASSOCIATION, OR FIDUCIARY RETURN

WHO MUST	Partnerships and fiduciaries must file their own Interest and Dividends tax return when all of the following apply:
FILE	1. The entity has over $2,400 of gross interest and dividend income.

	2. The partnership has a usual place of business in New Hampshire, or in the case of a trust, the location of the trust
	property is in this state, or at least one of the trustees is an inhabitant of New Hampshire, or the trustee was
	appointed by a New Hampshire court.
	3. The partnership has at least one New Hampshire owner, AND
	4. The entity has non-transferable shares (see Rev 901.02 or 901.03).
	Any organization whose shares or interests are transferable without obtaining prior member approval or causing a
	dissolution of the organization such as, but not limited to: a business trust, common law trust, Massachusetts trust,
	real estate investment trust, homeowners or condominium associations and employee benefit plans, SHALL NOT
	FILE AN INTEREST & DIVIDEND TAX RETURN.

WHAT TO	Report all interest and dividend income received from whatever source on page 2, lines 1(a), 1(b), and 1(c). Enter
REPORT	on line 4 the amounts which are non-taxable to New Hampshire. See the QUICK CHECKLIST, on page 6, for a
	listing of taxable and non-taxable income sources.

GRANTOR	The income received by estates held by trustees which are treated as grantor trusts under IRS Section 671 is
TRUSTS	included in the return of its owners.

NON-NEW	Partnership or trust interest and dividend income is subject to this tax only to the extent that the members/beneficiaries
HAMPSHIRE	are residents of this state or are unascertained. All interest and dividend income must be shown on lines 1(a), 1(b),
MEMBERS,	and 1(c). Enter on line 4 the prorata share attributable to non-NH resident members/beneficiaries. Indicate on the
BENEFICIARIES	return on page 1, step 2 the percentage of ownership attributable to New Hampshire members or beneficiaries.
OR OWNERS

EXEMPTIONS	The entity is entitled to one $2,400 exemption.

CHARITABLE	The portion of a trust’s income required to be donated to an exempt charity is not taxable.
CONTRIBUTIONS

DP-10

(5)Instructions

Rev. 12/99

	FORM		NEW HAMPSHIRE DEPARTMENT OF REVENUE ADMINISTRATION
	DP-10
			INTEREST AND DIVIDENDS TAX
	Checklist

QUICK CHECKLIST

Taxable to New Hampshire		Not Taxable to New Hampshire
	INTEREST
	INTEREST

•All Banks, credit unions, savings banks, building & loan associations, trust companies, including those in New Hampshire and Vermont

•Bonds, notes and money at interest and from all debts due the person being taxed unless specifically exempt

•Life insurance interest

•Private mortgages and loans

•Repurchase agreements

•Municipal bonds, EXCEPT New Hampshire

•Deemed interest

•Indirect obligations of the US Government including: Federal National Mortgage Association (FNMA), Government National Mortgage Association (GNMA), Federal Home Loan Mortgage Corporation, and Farmers Home Administration

•Annuities (except as part of an employee benefit plan as defined in ERISA of 1974 sec. 3, or the principal portion of life insurance proceeds)

•Annual calculated interest from zero coupon bonds

•OID interest as shown on your 1099

•Interest paid by the IRS

•New Hampshire State and New Hampshire Municipal bonds

•Individual Retirement Accounts

•Keogh Plans

•Tax Deferred Investment Plans

•Employee Benefit Plans as defined by ERISA of 1974, sec. 3

•Specifically exempted Puerto Rico, Guam & Virgin Islands bonds

•Direct obligations of the US Government including: Treasury Bills, US Savings Bonds, Treasury Bonds, Federal Home Loan Banks, US Postal Securities, Small Business Administration, Tennessee Valley Authority, Farm Credit System, Federal Financing Bank, General Services Administration, Student Loan Marketing Association (SLMA), and Resolution Funding Corporation

•New Hampshire Housing Authority Bonds, Industrial Development Authority, New Hampshire Higher Education and Health Facilities Authority, Firemen’s Retirement, New Hampshire Retirement System, State Retirement Allowance

•Interest received from funds invested in the college tuition savings plan under RSA 195-H

— DIVIDENDS —

•

••

Banks and bank holding companies

All dividends unless specifically exempt by law Corporations (including NH Corporations)

Mutual funds EXCEPT portion generated from direct obligations of the US Government or from capital gains

Automatic reinvestments

Income from partnerships, associations, or trusts (see instructions for exceptions)

Actual distributions from S Corporations (see instructions)

Fair market value of distributed property by a business organization

Forgiveness of debt by an organization

Personal expenditures made by an organization for an individual and the fair market value of any property transfered

World Bank dividends Deemed dividends

•Capital gains, or any portion of the dividend that represents capital gain

•Return of capital, or any portion of the dividend that represents return of capital

•Stock dividends paid in new stock (not automatic reinvestment of mutual funds)

•Liquidating dividends

•Individual Retirement Accounts

•Keogh Plans

•Tax deferred investment plans

•Sale or exchange of transferable shares

•1099 PATR (Patronage Dividends)

•Mutual funds which invest solely in New Hampshire tax-exempt instruments

•Dividends received from funds invested in the college tuition savings plan under RSA 195-H

	DP-10
(6)	Instructions
(6)	Rev. 12/99

Question	Answer
Form Name	Dp 10 Form
Form Length	8 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	2 min
Other names	nh dp 10 2020, nh dp10, nh 2018 dp 10, 2020 dp 10 instructions

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