Form Dp-10-Es - Interest And Dividends Tax - 1999 Page 2
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2FORM
NEW HAMPSHIRE DEPARTMENT OF REVENUE ADMINISTRATION
DP-10-ES
1999
ESTIMATED INTEREST AND DIVIDENDS TAX
042
CHECK ONE :
INDIVIDUAL/JOINT
PARTNERSHIP
FIDUCIARY
Payment Voucher 2
1999
For CALENDAR year
or other tax year beginning
ending
Calendar Year — Due June 15, 1999
Mo
Day
Year
Mo
Day
Year
LAST NAME
FIRST NAME & INITIAL
SOCIAL SECURITY NUMBER
P
R
SPOUSE’S LAST NAME
FIRST NAME & INITIAL
I
N
SPOUSE’S SOCIAL SECURITY NUMBER
T
NAME OF PARTNERSHIP OR FIDUCIARY
O
R
NUMBER AND STREET
FEDERAL EMPLOYER IDENTIFICATION NUMBER
T
(PARTNERSHIP OR FIDUCIARY)
Y
P
E
CITY OR TOWN, STATE AND ZIP CODE
Amount of This Payment
$
ç
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
(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 3
1999
For CALENDAR YEAR
or other tax year beginning
ending
Calendar Year — Due Sept. 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
SPOUSE’S SOCIAL SECURITY NUMBER
T
NAME OF PARTNERSHIP OR FIDUCIARY
O
R
NUMBER AND STREET
FEDERAL EMPLOYER IDENTIFICATION NUMBER
T
(PARTNERSHIP OR FIDUCIARY)
Y
P
E
CITY OR TOWN, STATE AND ZIP CODE
Amount of This Payment
$
ç
CHECK IF ADDRESS IS DIFFERENT FROM 1998 RETURN.
Make check payable to: STATE OF NEW HAMPSHIRE
Enclose, but do not staple or tape, your payment
NH DEPT REVENUE ADMINISTRATION
MAIL
Document Processing Division
with this estimate. Do not file a $0 estimate.
TO:
PO Box 2035
Concord, NH
03302-2035
(Cut along this line)
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
FORM
NEW HAMPSHIRE DEPARTMENT OF REVENUE ADMINISTRATION
DP-10-ES
1999
ESTIMATED INTEREST AND DIVIDENDS TAX
042
FIDUCIARY
CHECK ONE:
INDIVIDUAL/JOINT
PARTNERSHIP
Payment Voucher 4
1999
Calendar Year — Due Jan. 18, 2000
For CALENDAR year
or other tax year beginning
ending
Mo
Day
Year
Mo
Day
Year
LAST NAME
FIRST NAME & INITIAL
SOCIAL SECURITY NUMBER
P
R
I
SPOUSE’S LAST NAME
FIRST NAME & INITIAL
SPOUSE’S SOCIAL SECURITY NUMBER
N
T
NAME OF PARTNERSHIP OR FIDUCIARY
O
R
FEDERAL EMPLOYER IDENTIFICATION NUMBER
NUMBER AND STREET
(PARTNER SHIP OR FIDUCIARY)
T
Y
P
E
CITY OR TOWN, STATE AND ZIP CODE
ç
Amount of This Payment
$
CHECK IF ADDRESS IS DIFFERENT FROM 1998 RETURN.
Make check payable to: STATE OF NEW HAMPSHIRE
NH DEPT REVENUE ADMINISTRATION
MAIL
Enclose, but do not staple or tape, your payment
Document Processing Division
TO:
with this estimate. Do not file a $0 estimate.
PO Box 2035
Concord, NH
03302-2035
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