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FORM

NEW HAMPSHIRE DEPARTMENT OF REVENUE ADMINISTRATION

DP-10

INTEREST AND DIVIDENDS TAX

Instructions

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

Rev. 12/99

(4)

Form Dp-10 - Interest And Dividends Tax Instructions - New Hampshire Department Of Revenue Administration - 1999 Page 4

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