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               New Hampshire  
                    Department of                                  ED-03
         Revenue Administration

                                      EDUCATION TAX CREDIT SCHOLARSHIP RECEIPT
  PRINT OR TYPE
   STEP 1
1. Receiving Scholarship Organization                                                        4. Taxpayer Identification Number

2. Number & Street Address                                                                                                                                       DIN FEIN      SSN

3. City / Town                               State Zip Code + 4 (or Canadian Postal Code)

  STEP 2
5. Donating Business Organization/Enterprise or Individual Name                              8. Taxpayer Identification Number

6.
   Number & Street Address                                                                                                                                       DIN FEIN      SSN

7. City / Town                               State Zip Code + 4 (or Canadian Postal Code)

  STEP 3
  Donation Amount: ............................................................................................................................................ $

  Date donation was received or postmarked, whichever is earlier: ......................................................................      

  STEP 4
   I certify that the scholarship organization received the donation listed from the business organization/enterprise or individual 
   on the date shown above.

               AUTHORIZED SIGNATURE (IN INK)                                             DATE

               PRINT SIGNATORY NAME & TITLE

This Scholarship Receipt must be filed with the Department of Revenue Administration and a copy sent to the donating business organization/
enterprise or individual within 15 days of receipt of the donation.

                           Mail to NH DRA, Education Tax Credit, PO Box 637, Concord NH 03302-0637

   ED-03
   Rev. 1.2  04/2020

            New Hampshire  
                   Department of                                  ED-03
          Revenue Administration

                   EDUCATION TAX CREDIT SCHOLARSHIP RECEIPT INSTRUCTIONS

WHO MUST FILE?  
Scholarship organizations who received donations under RSA 77-G must file an Education Tax Credit Scholarship Receipt (Form ED-03) for each 
business organization, business enterprise or individual who made a donation. 
  
WHEN TO FILE?  
Form ED-03 must be filed with the Department of Revenue Administration and a copy sent to the donating business organization/enterprise, or 
individual within 15 days of receipt of the donation. 
  
WHERE TO FILE?  
Mail to NH DRA Education Tax Credit, PO Box 457, Concord NH 03302-0457. 
  
FORMS SHALL NOT BE FAXED OR EMAILED.
  
NEED HELP?  
Call the Department at (603) 230-5920, Monday through Friday, 8:00am - 4:30pm. For more information visit us on the web at: www.revenue.nh.
gov. Hearing or speech impaired individuals may call TDD Access: Relay NH 1-800-735-2964. 
  
LINE-BY-LINE INSTRUCTIONS  
  
STEP 1  
  
Line 1  
Enter the scholarship organization's name. 
  
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 business organization's, business enterprise's, or the individual's taxpayer identification number; Department Identification Number 
(DIN),  Federal Taxpayer Identification Number (FEIN), or Social Security Number (SSN). 
  
STEP 2  
  
Line 5  
Enter the donating business organization's, business enterprise's, or individual's name.  
  
Line 6  
Enter the donating business organization's, business enterprise's, or individual's street address.  
  
Line 7  
Enter the donating business organization's, business enterprise's, or individual's city, state and zip code.  
  
Line 8  
Enter the donating business organization's or business enterprise's Federal Taxpayer Identification Number, or the donating individual's Social 
Security Number. 
  
STEP 3  
Enter the donation amount from the business organization, business enterprise, or individual, and the date the donation was received or 
postmarked, whichever is earlier. 
  
STEP 4  
The application must be dated and signed in ink by an officer or authorized agent, or by the individual. In addition, print the name and title of the 
officer, authorized agent, or individual signing the application. 
 
  ED-03
  Rev. 1.2  04/2020