Form Dp-151 - Smokeless And Loose Tobacco Tax Return
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1
2NEW HAMPSHIRE DEPARTMENT OF REVENUE ADMINISTRATION
FORM
DP-151
SMOKELESS AND LOOSE TOBACCO TAX RETURN
081
FOR DRA USE ONLY
For tax period beginning
and ending
Mo
Da y
Year
Mo
Da y
Year
Due date is the 15th day following the end of the reporting period.
STEP 1
WHOLESALER
LICENSE NUMBER
PLEASE
PRINT OR
NUMBER AND STREET
FEDERAL EMPLOYER IDENTIFICATION NUMBER
TYPE
CITY/TOWN, STATE & ZIP CODE
Filing Status (Check One)
Monthly
Quarterly
Check one of the following ONLY if applicable (see instructions)
STEP 2
Contact Telephone Number (Optional)
RETURN
INITIAL RETURN
AMENDED RETURN
FINAL RETURN
TYPE
STEP 3
1 Smokeless Tobacco sold or distributed in New Hampshire .................
1
FIGURE
YOUR
2 Loose Tobacco sold or distributed in New Hampshire ...........................
2
TAX
3 New Hampshire Smokeless and Loose Tobacco
(Line 1 plus Line 2) ............................................................................... 3
4 New Hampshire Smokeless and Loose Tobacco Tax
(Line 3 x
%)(see instructions for applicable percentage) ..
4
5 Credits:
STEP 4
(a) Advance payments ........................................................................ 5(a)
FIGURE
YOUR
(b) Credit carried over from prior taxable period ................................ 5(b)
CREDITS
INTEREST
(c) Paid with original return (Amended Return only) .......................... 5(c)
AND
PENALTIES
5
Enter the sum of Lines 5(a) through 5(c) .................................................
5
6 Balance of tax due (Line 4 minus Line 5) .................................................
6
7 Additions to tax:
(a) Interest ........................................................................................... 7(a)
(b) Failure to Pay .................................................................................. 7(b)
(c) Failure to File .................................................................................. 7(c)
7 Enter the sum of Lines 7(a) through 7(c) .................................................
7
STEP 5
PAY THIS AMOUNT
8 Balance due with this return (Line 6 plus Line 7) ...................................
8
FIGURE
Make Check Payable to: State of New Hampshire
YOUR
DO NOT PAY
9 Overpayment (Line 4 minus Line 5 plus Line 7) .....................................
9
BALANCE
10 Apply Overpayment to:
OR
(a) Credit applied to next tax period ...................................................
10(a)
OVERPAY-
DO NOT PAY
MENT
(b) Refund (allow 12 weeks for processing) ....................................
10(b)
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.
SIGNA-
TURE
If prepared by a person other than the taxpayer, this declaration is based on all information of which the preparer has knowledge.
SIGNATURE (IN INK) OF WHOLESALER
SIGNATURE (IN INK) OF PAID PREPARER OTHER THAN TAXPAYER
TITLE
DATE
TITLE
DATE
PREPARER'S TAX IDENTIFICATION NUMBER
PREPARER'S ADDRESS
FOR DRA USE ONLY
CITY/TOWN, STATE & ZIP CODE
NH DEPT REVENUE ADMINISTRATION
DOCUMENT PROCESSING DIVISION
MAIL
PO BOX 637
TO:
DP-151
CONCORD NH
03302-0637
Rev. 2/23/07
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