Fillable Form Dp-87 Id - Interest And Dividends Tax printable pdf download

FORM

NEW HAMPSHIRE DEPARTMENT OF REVENUE ADMINISTRATION

INTEREST AND DIVIDENDS TAX

DP-87 ID

REPORT OF CHANGE FOR IRS ADJUSTMENT ONLY

045

_____

For the CALENDAR year

or other taxable period beginning

and ending

FOR DRA USE ONLY

Day

Year

Day

Year

STEP 1

LAST NAME

FIRST NAME & INITIAL

TAXPAYER IDENTIFICATION NUMBER

Print or

SPOUSE’S LAST NAME

FIRST NAME & INITIAL

TAXPAYER IDENTIFICATION NUMBER

Type

NAME OF PARTNERSHIP OR FIDUCIARY

TAXPAYER IDENTIFICATION NUMBER

NUMBER & STREET ADDRESS

ADDRESS (Continued)

CITY/TOWN, STATE & ZIP CODE+4

STEP 2

INDIVIDUAL

PARTNERSHIP

}

% of NEW HAMPSHIRE

Entity

FIDUCIARY

Ownership Interest

JOINT

Type

STEP 3

1 FROM YOUR FEDERAL INCOME TAX RETURN: As originally ﬁ led or previously adjusted

IRS

(a) INTEREST INCOME [from DP-10, Page 2, Line 1(a)] .........................................................................1(a)

Adjustments

(b) DIVIDEND INCOME [from DP-10, Page 2, Line 1(b)]..........................................................................1(b)

(d) SUBTOTAL INTEREST AND DIVIDEND INCOME [Sum of Lines 1(a), 1(b) and 1(c)] .......................1(d)

2 TOTAL DISTRIBUTIONS [as originally ﬁ led or previously adjusted [from DP-10, Page 2, Line 2] .................. 2

3 SUBTOTAL INTEREST & DIVIDENDS INCOME AND DISTRIBUTIONS as adjusted line 1(d) plus Line 2 ................. 3

4 INTERNAL REVENUE SERVICE ADJUSTMENTS TO FEDERAL INCOME:........................................... 4

(a) AMOUNT OF CHANGE TO INTEREST INCOME from Page 2, Section 1, Line 1 .............................4(a)

(b) AMOUNT OF CHANGE TO DIVIDEND INCOME from Page 2, Section 2, Line 2. ...........................4(b)

(d) AMOUNT OF CHANGE TO OTHER INCOME from Page 2, Section 4, Line 4 ................................4(d)

(e) SUBTOTAL combine Lines 4(a), 4(b), 4(c) and 4(d) ...........................................................................4(e)

5 Subtotal Interest & Dividend Income and Distribution as adjusted by IRS adjustments

Line 3 adjusted by Line 4(e) ......................................................................................................................... 5

6 TOTAL NON-TAXABLE INCOME as originally ﬁ led or previously adjusted (from DP-10, Pg 2, Line 4) ................ 6

7 GROSS TAXABLE INCOME AS ADJUSTED BY IRS ADJUSTMENTS (Line 5 minus Line 6) ............... 7

8 LESS: $2,400 for Individual, Partnership and Fiduciary; $4,800 for Joint ﬁ lers ......................................... 8

9 ADJUSTED TAXABLE INCOME (Line 7 minus Line 8). If negative show in parenthesis ....................... 9

10 CHECK THE EXEMPTIONS THAT APPLY.

Spouse

Blind

Spouse Blind

65 (or over) or disabled

Year of birth _________

Multiply the total number of boxes checked above _________ x 1,200 =

11 NET TAXABLE INCOME (Line 9 minus Line 10) If less than zero, enter amount in parenthesis ............. 11

STEP 4

12 NEW HAMPSHIRE INTEREST AND DIVIDENDS TAX AS ADJUSTED BY IRS ADJUSTMENTS

(Line 11 multiplied by 5%) ............................................................................................................................ 12

Figure

Your Tax,

13 NEW HAMPSHIRE INTEREST AND DIVIDENDS TAX as originally ﬁ led or previously adjusted ................ 13

Interest

14 BALANCE OF TAX DUE (Line 12 minus Line 13) ....................................................................................... 14

and

Penalties

15 INTEREST DUE (see DP-87 instructions) ............................................................................................... 15

PAY THIS AMOUNT

16 BALANCE DUE (Line 14 plus Line 15) (If less than $1.00 do not pay) .................................................. 16

17 REFUND DUE (Line 13 adjusted by Line 12) .......................................................................................... 17

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.