Form Dp-10 - Interest And Dividends Tax Return 1998 Page 3
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REPORT OF INTEREST AND DIVIDENDS INCOME
TAX YEAR 1998
DP-10
1
From Your Federal 1040 Income Tax Return: (Partnerships and Fiduciaries, see Instructions)
(a) Interest Income. Enter the amount from line 8(a). ........................................................................................1(a)
1(b)
(b) Dividend Income. Enter the amount from line 9.............................................................................................
(c)
Federal Tax Exempt Interest Income. Enter the amount from line 8(b). ....................................................1(c)
2
List Payments From S-Corporations, Partnerships, and Fiduciaries: See instructions
Entity codes: 2=”S” or other Corporations; 3=Partnerships; 4=Trusts or Estates; 5=Other
(A)
(B)
(C)
(D)
ENTITY
PAYER’S IDENTIFICATION
DISTRIBUTION
NAME OF
CODE
PAYER
AMOUNT
NUMBER
Total from supplemental schedule attached
2 Total Distributions...............................................................................................................2
3 Subtotal Sum of lines 1(a), 1(b), 1(c) and 2..........................................................................3
4 List payers and amounts of interest and/or dividends NOT TAXABLE to NH included on lines 1(a), 1(b), 1(c),
and/or 2: (See instructions)
(A)
(B)
(C)
(D)
REASON
NAME OF
NON-TAXABLE
PAYER’S IDENTIFICATION
AMOUNT
CODE
PAYER
NUMBER
Total from supplemental schedule attached
4
Total Non-Taxable Amount.................................................................................................4
(Line 3 minus line 4).
5
5 Gross Taxable Income
ENTER THIS AMOUNT ON PAGE 1, LINE 6........
(2)
D P - 1 0
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