Form Dp-134 - Application For 31 Day Extension Of Time To File Electricity Consumption Tax Return - 2011
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1FORM
NEW HAMPSHIRE DEPARTMENT OF REVENUE ADMINISTRATION
DP-134
APPLICATION FOR 31 DAY EXTENSION OF TIME TO FILE
ELECTRICITY CONSUMPTION TAX RETURN
623
FOR DRA USE ONLY
IMPORTANT: AN EXTENSION OF TIME TO FILE YOUR NEW HAMPSHIRE ELECTRICITY CONSUMPTION TAX RETURN IS SUBJECT TO
APPROVAL PURSUANT TO RSA 83-E:5,V.
WHEN TO USE THIS FORM
REASONS FOR DENIAL
Applications for extension will be rejected for reasons such as, but
If your extension is approved, you may fi le your New Hampshire
not limited to, failure to complete the tax payment schedule, absence
Electricity Consumptions Tax return up to 31 days beyond the original
of the provider or consumer or authorized agent’s signature, the
due date and you will not be subject to the late fi ling penalty. Please
application was postmarked after the due date for fi ling the return,
note that an extension of time to fi le your return is not an extension of
or the payment for the balance due shown on line 3 below did not
time to pay the tax.
accompany this application.
If the information required for the making of an accurate return cannot
WHERE TO FILE
reasonably be compiled by a provider or consumer within 45 days after
NH DRA - Audit Division
the close of the calendar month for which the return is to be made, the
109 Pleasant St
provider or consumer may request an extension of time for fi ling the
PO Box 457
return for a period not to exceed 31 calendar days.
Concord NH 03302-0457
If you need to make an additional payment in order to have paid 100%
of the tax determined to be due, then you must submit this form with
NEED HELP?
payment by the original due date in order to be granted an extension
Call the New Hampshire Department of Revenue Administration, Audit
of time to fi le your return.
Division, at (603) 271-3400. Hearing or speech impaired individuals
may call TDD Access: Relay NH 1-800-735-2964.
WHEN TO FILE
This application and payment must be postmarked on or before the
original due date of the return.
APPLICATION FOR 31 DAY EXTENSION OF TIME TO FILE ELECTRICITY CONSUMPTION TAX
PRINT OR TYPE
NAME OF PROVIDER OR CONSUMER
FEDERAL EMPLOYER IDENTIFICATION NUMBER
NUMBER & STREET ADDRESS
SOCIAL SECURITY NUMBER
ADDRESS (continued)
CITY/TOWN, STATE & ZIP CODE+4
For the Month of
or
Year Ending
Mo
Year
Year
TAX PAYMENT SCHEDULE
1
1 Enter 100% of the Electricity Consumption Tax determined to be due...................................
2
2 LESS: Credits.........................................................................................................................
3
3 BALANCE DUE: Make check payable to: State of New Hampshire...................................
If line 3 is negative or zero, do not fi le this application.
FOR DRA USE ONLY
NH DRA
MAIL
Your application for a 31 day extension has been:
AUDIT DIVISION
TO:
PO BOX 457
CONCORD, NH 03302-0457
Approved
Denied
FOR DRA USE ONLY
Signature
Date
A copy of this approved application must be attached to the Electricity
Consumption Tax Return.
DP-134
Rev 02/2011
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