Form Dp-10-Es - Interest And Dividends Tax - 1999
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1
2FORM
DP-10-ES
INTEREST AND DIVIDENDS TAX
042
1999 TAXPAYER’S WORKSHEET – KEEP FOR YOUR RECORDS
1 All interest and dividend income taxable by the State...........................................................1
2 Less Exemption – check the exemptions that apply:
2(a)
Yourself
Spouse
Partnership
Fiduciary
Total number of boxes checked ________ x $2400 =2(a)
2(b)
65 (or over) or disabled
Blind
Total number of boxes checked ________ x $1200 =2(b)
Spouse 65 (or over) or disabled
Spouse Blind
2
......2
(c)Total exemptions [Line 2(a) plus 2(b)].............................................................................
(c)
{
3 New Hampshire Taxable Income [Line 1 less line 2(c)]......................................................3
If less than $200
see instructions
4 New Hampshire Interest & Dividends Tax (Line 3 multiplied by 5%).................................4
paragraph No. 1.
5 1998 OVERPAYMENT applied to 1999 taxes......................................................................... 5
1
(If the overpayment exceeds the first
/
installment, the overage will be applied to
4
the next installment and so on)
6 BALANCE OF ESTIMATED INTEREST & DIVIDENDS TAX (Line 4 less line 5)..................6
COMPUTATION and RECORD of PAYMENTS
Amount of each
1998 Overpayment
Date Paid
Installment
Applied to
Balance
CALENDAR YEAR
Installment
Due
DUE DATES
1
(
/
of line 4 of worksheet)
4
1. ..................................
$ ..............................................
$ ..............................................
$ ..............................................
April 15, 1999
2. ..................................
$ ..............................................
$ ..............................................
$ ..............................................
June 15, 1999
3. ..................................
$ ..............................................
$ ..............................................
$ ..............................................
Sept. 15, 1999
4. ..................................
$ ..............................................
$ ..............................................
$ ..............................................
Jan. 18, 2000
IMPORTANT
PLEASE PUT THE NAMES AND SOCIAL SECURITY NUMBERS ON THE ESTIMATE FORM
:
IN THE SAME SEQUENCE AS THOSE TO BE USED ON THE RETURN.
THE PENALTY PROVISIONS OF RSA 21-J:32 WILL APPLY IF THE ESTIMATE REQUIRE-
MENTS HAVE NOT BEEN MET.
(Cut along this line)
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
FORM
NEW HAMPSHIRE DEPARTMENT OF REVENUE ADMINISTRATION
DP-10-ES
1999
ESTIMATED INTEREST AND DIVIDENDS TAX
042
CHECK ONE:
INDIVIDUAL/JOINT
PARTNERSHIP
FIDUCIARY
Payment Voucher 1
1999
For CALENDAR YEAR
or other tax year beginning
ending
Calendar Year — Due April 15, 1999
Mo
Day
Year
Mo
Day
Year
LAST NAME
FIRST NAME & INITIAL
SOCIAL SECURITY NUMBER
P
R
I
SPOUSE’S LAST NAME
FIRST NAME & INITIAL
N
T
SPOUSE’S SOCIAL SECURITY NUMBER
NAME OF PARTNERSHIP OR FIDUCIARY
O
R
NUMBER AND STREET
T
FEDERAL EMPLOYER IDENTIFICATION NUMBER
Y
(PARTNERSHIP OR FIDUCIARY)
P
E
CITY OR TOWN, STATE AND ZIP CODE
Amount of This Payment $
CHECK IF ADDRESS IS DIFFERENT FROM 1998 RETURN.
NH DEPT REVENUE ADMINISTRATION
Make check payable to: STATE OF NEW HAMPSHIRE
MAIL
Document Processing Division
Enclose, but do not staple or tape, your payment
TO:
PO Box 2035
with this estimate. Do not file a $0 estimate.
Concord NH 03302-2035
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