Form Dp-200 - Request For Department Identification Number (Din) - New Hampshire Department Of Revenue Administration
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1FORM
NEW HAMPSHIRE DEPARTMENT OF REVENUE ADMINISTRATION
DP-200
REQUEST FOR DEPARTMENT IDENTIFICATION NUMBER (DIN)
980
FOR DRA USE ONLY
INSTRUCTIONS
WHO MUST
All Single Member Limited Liability Companies (SMLLC), any taxpayer who shares a taxpayer identification number with another
FILE
taxpayer subject to taxation, any taxpayer who is not required to obtain a federal taxpayer identification number or social security
number, or any taxpayer electing to obtain a DIN for New Hampshire in lieu of their FEIN or SSN.
PURPOSE
To obtain an identifying number which is required to file New Hampshire tax related documents. SMLLC's are required by New
Hampshire Law to file a separate entity tax return even though the SMLLC does NOT file a separate federal tax return. A New Hampshire
Department of Revenue Administration assigned number, Department Identification Number (DIN), is necessary in order to process all tax
related documents for taxpayers as described in "Who Must File" above.
WHEN TO
This form must be filed at least 30 days prior to the due date of your first business tax document. Any changes in the registration
FILE
information must be provided to the Department at least 30 days prior to the change.
WHERE TO
NH Department of Revenue Administration, Document Processing Division, PO Box 637, Concord NH 03302-0637
FILE
FACSIMILE DOCUMENTS ARE NOT ACCEPTED
NEED HELP
Call the Department of Revenue Administration, Central Taxpayer Services at (603) 271-2191. Individuals with hearing or speech
impairments may call TDD Access: Relay NH 1-800-735-2964.
BUSINESS ENTITY INFORMATION
BUSINESS NAME
BUSINESS NUMBER & STREET ADDRESS
FOR DRA USE ONLY
D I N
BUSINESS ADDRESS (continued)
BUSINESS CITY/TOWN, STATE & ZIP CODE
SMLLC's and taxpayers electing to obtain a DIN, MUST USE THE DEPARTMENT IDENTIFICATION NUMBER WHEN FILING ANY AND ALL TAX
RELATED DOCUMENTS.
Your Department assigned number shall be used in place of the member's federal employer identification number or social
security number. When filing all future documents, the department identification number shall be entered wherever federal
employer identification numbers or social security numbers are required.
MEMBER OR TAXPAYER INFORMATION
MEMBER OR TAXPAYER NAME
MEMBER'S SSN OR FEIN
MEMBER OR TAXPAYER NUMBER & STREET ADDRESS
ADDRESS (continued)
MEMBER OR TAXPAYER CITY/TOWN, STATE & ZIP CODE
1
Proprietorship
2
Corporation/Combined Group
3
Partnership
4
Fiduciary
ENTITY TYPE:
Yes, for federal income tax purposes, the income of the SMLLC will be reported on the tax return of the member as listed above.
No, for federal income tax purposes, the income of the SMLLC will NOT be reported on the tax return of the member as listed above.
THE INCOME WILL BE REPORTED ON THE TAX RETURN FOR:
MEMBER'S SSN OR FEIN
NAME
NUMBER & STREET ADDRESS
ADDRESS (continued)
CITY/TOWN, STATE & ZIP CODE
Under penalties as provided by law, I declare that I have examined this application, and to the best of my knowledge and belief, it
is true, correct and complete.
x
FOR DRA USE ONLY
SIGNATURE (IN INK) OF APPLICANT
DATE
x
SIGNATURE (IN INK) OF OFFICER OF CORPORATION IF OTHER THAN OWNER
DATE
TITLE
NH DEPT OF REVENUE ADMINISTRATION
MAIL
DOCUMENT PROCESSING DIVISION
TO:
PO BOX 637
DP-200
CONCORD NH 03302-0637
Rev. 10/1/06
103
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