Form Ed-04 - Education Tax Credit Scholarship Receipt - 2015 Page 2
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1
2New Hampshire
2013
Department of
ED-04
Revenue Administration
EDUCATION TAX CREDIT SCHOLARSHIP RECEIPT INSTRUCTIONS
WHO MUST FILE?
LINE-BY-LINE INSTRUCTIONS CONTINUED
Scholarship organizations who received donations under
STEP 2
RSA 77-G must send an Education Tax Credit Scholarship
Receipt (Form ED-04) to each business organization or
LINE 5 Enter the business organization's or business
business enterprise who made a donation and the
enterprise's name who made a donation.
Department of Revenue Administration. This receipt will
LINE 6 Enter the business organization's or business
show the donor exactly how much of their donation was
enterprise's street address.
used. 85% of the donation used may be applied as a tax
credit against the business organization or business
LINE 7 Enter the business organization's or business
enterprise's New Hampshire business tax liability for the tax
enterprise's city, state and zip code.
year in which the donation was made.
LINE 8 Enter the business organization's or business
enterprise's Federal Taxpayer Identification Number.
WHEN TO FILE?
Form ED-04 must be sent to the donating business
organization/enterprise and a copy to the Department of
Revenue Administration by December 1, 2015.
STEP 3
WHERE TO FILE?
LINE 9 Enter the donation amount used from a business
Form ED-04 may be mailed to:
organization or business enterprise.
NH DRA
LINE 10 Enter the donation amount carried forward.
Education Tax Credit
PO Box 488
LINE 11 Enter 85% of the donation amount used by
Concord, NH 03302-0488
multiplying Line 9 by .85.
Or may be hand-delivered to the Department of Revenue
LINE 12 Enter the amount of the donation from the
Administration during business hours (Monday through
business organization or business enterprise that was not
Friday, 8:00 a.m. to 4:30 p.m.) at:
used.
Governor Hugh J. Gallen Office Park South
109 Pleasant Street
STEP 4
Medical and Surgical Building
Concord, NH
By signing this receipt, you are certifying that the donation
amount used was expended properly by the scholarship
organization and that the scholarship organization returned
NEED HELP?
the unused donation or portion thereof to the business
Call the Education Tax Credit Line at (603) 230-5018.
organization or business enterprise. The application must
For more information visit us on the web at:
be dated and signed in ink by the officer or authorized
Hearing or speech impaired
agent. In addition, print the name and title of the officer or
individuals may call TDD Access: Relay NH 1-800-735-2964.
authorized agent signing the application.
LINE-BY-LINE INSTRUCTIONS
NOTICE
In order for the donating business organization/
STEP 1
enterprise to take the tax credit available, this
scholarship receipt must be attached to the donating
LINE 1 Enter the scholarship organization's name.
business organization/enterprise's tax return when
filed with the Department.
LINE 2 Enter the scholarship organization's street address.
LINE 3 Enter the scholarship organization's city, state and
zip code.
LINE 4 Enter the scholarship organization's Federal
Taxpayer Identification Number.
ED-04-Instructions
Rev 1 10/2014
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