Form Dp-10 - Interest And Dividends Tax Return 1998
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NEW HAMPSHIRE DEPARTMENT OF REVENUE ADMINISTRATION
DP-10
INTEREST AND DIVIDENDS TAX RETURN 1998
041
1998
For the CALENDAR year
or other tax year beginning
and ending
Mo
Day
Year
Mo
Day
Year
Due Date for CALENDAR year is on or before April 15, 1999 or the 15th day of the 4th month after the close of the fiscal period.
LAST NAME
FIRST NAME & INITIAL
STEP 1
SOCIAL SECURITY NUMBER
SPOUSE’S LAST NAME
FIRST NAME & INITIAL
Please Print
or Type
SPOUSE’S SOCIAL SECURITY NUMBER
NAME OF PARTNERSHIP OR FIDUCIARY
NUMBER AND STREET ADDRESS
FEDERAL EMPLOYER IDENTIFICATION NUMBER
(Partnership or Fiduciary)
CITY OR TOWN, STATE AND ZIP CODE
STEP 2
INDIVIDUAL
JOINT
PARTNERSHIP
FIDUCIARY Y
% of NH Ownership
_________
Entity Type
Check here if you would like your forms mailed to an address other than the above. (See instructions)
and Mailing
Information
Number and Street Address
City/Town
State
Zip
STEP 3
INITIAL RETURN: Date established residency.......................................................................................
Mo
Day
Year
Special
FINAL RETURN: Date abandoned residency.........................................................................................
Return Type
Mo
Day
Year
FINAL RETURN: Deceased taxpayer: Social Security # _____ – ____ – ______ Date of death
Mo
Day
Year
AMENDED RETURN Note: DO NOT USE this form to report an IRS adjustment. File FORM DP-87 A.
STEP 4
COMPLETE PAGE 2 BEFORE COMPUTING TAX
STEP 5
6 Gross Taxable Income (Page 2, line 5) ............................................................................................... 6
Figure Your
7 Less: $2,400 Individual, Partnership, and Fiduciary; $4,800 Joint ................................................. 7
Net Taxable
8 Adjusted Taxable Income (Line 6 less line 7) .................................................................................... 8
Income
FOR INDIVIDUAL/JOINT FILERS ONLY: IF LINE 8 IS ZERO OR LESS, YOU ARE NOT REQUIRED TO FILE.
HOWEVER, TO BE REMOVED FROM OUR MAILING LIST CHECK HERE AND MAIL IN THE RETURN. ........................
9 Deduction for Contribution to Qualified Investment Capital Company (see instructions).......... 9
10 Check the exemptions that apply
Blind
Spouse Blind
65 (or over) ____________ or disabled
Spouse 65 (or over) ____________ or disabled
Year of Birth
Year of Birth
Total number of boxes checked ___________________ x $1,200= __________________ 10
11 Net Taxable Income (Line 8 less lines 9 and 10) ........................................................................... 11
STEP 6
12 New Hampshire Interest and Dividends Tax (Line 11 x 5%) ...................................................... 12
Figure Your
13 Payments: (a) Tax paid with Application for Extension ...................... 13(a)
Tax, Credits,
Interest and
(b) Payment from 1998 Declaration of Estimated Tax .... 13(b)
Penalties
(c) Credit carryover from prior years ................................. 13(c)
(d) Paid with original return (Amended returns only)....... 13(d)
13
14 Balance of Tax Due (Line 12 less line 13) ...................................................................................... 14
15 Additions to Tax: (a) Interest
15(a)
(See instructions) ....................................................
(b) Failure to Pay
15(b)
(See instructions) ......................................
(c) Failure to File
15(c)
(See instructions) ........................................
(d) Underpayment of Estimated Tax
15(d)
15
(See instructions)
STEP 7
16 Total Balance Due (Line 14 plus line 15)
............................... 16
Make check payable to: State of New Hampshire.
Enclose, but do not staple or tape, your payment with this return.
Balance
17 OVERPAYMENT (Line 13 less line 12 adjusted by line 15, if applicable)17
Due or
Overpayment
18 Amount of line 17 to be applied to:
(a)
..........18(a)
Your 1999 tax liability ...........................................
(b)
8(b)
Refund - Please allow 12 weeks for processing............1
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.
If prepared by a person other than the taxpayer, this declaration is based on all information of which the preparer has knowledge.
Signature
Date
Signature of Paid Preparer Other Than Taxpayer
If joint return, BOTH husband and wife must sign, even if only one had income.
Date
Preparer’s Identification Number
Date
ç
NH DEPT REVENUE ADMINISTRATION
Preparer’s Address
DOCUMENT PROCESSING DIVISION
MAIL TO:
PO BOX 2072
City or Town, State, and Zip Code
D P - 1 0
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