Form Nh-1041-Es-2012 - Estimated Fiduciary Business Tax Payment Forms
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1
2New Hampshire
2012
ESTIMATED FIDUCIARY
Department of
NH-1041-ES
BUSINESS TAX Payment Form 1
Revenue Administration
2012
MAIL TO: NH DRA,
For the CALENDAR year
or other taxable period beginning:
PO BOX 637,
MMDDYYYY
MMDDYYYY
Federal Employer Identification #
CONCORD NH 03302-0637
and ending:
Make Check Payable to:
STATE OF NEW HAMPSHIRE
Name of Estate or Trust
Number & Street Address
Address (continued)
City / Town
State
Zip Code + 4 (or Canadian Postal Code)
Enclose, but do not staple or tape
0
1/4 BET
1
your payment to this estimate.
1041ES1111862
Do not file a $0 estimate.
0
1/4 BPT
2
Amount of
0
3
Payment
ded75d93-2523-4cdc-83ef-a8cc3cff3ec7
NH-1041-ES
Rev 3 1/2012
Cut along this line to submit Estimated Fiduciary Business Tax. Keep the Estimated Tax Worksheet for your records
New Hampshire
2012
ESTIMATED FIDUCIARY
Department of
NH-1041-ES
BUSINESS TAX Payment Form 2
Revenue Administration
2012
MAIL TO: NH DRA,
For the CALENDAR year
or other taxable period beginning:
PO BOX 637,
MMDDYYYY
MMDDYYYY
Federal Employer Identification #
CONCORD NH 03302-0637
and ending:
Make Check Payable to:
STATE OF NEW HAMPSHIRE
Name of Estate or Trust
Number & Street Address
Address (continued)
State
Zip Code + 4 (or Canadian Postal Code)
City / Town
Enclose, but do not staple or tape
0
1/4 BET
1
your payment to this estimate.
1041ES1111862
Do not file a $0 estimate.
0
1/4 BPT
2
Amount of
0
3
Payment
ded75d93-2523-4cdc-83ef-a8cc3cff3ec7
NH-1041-ES
Page 2 of 4
Rev 4.1 2/2012
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