New Hampshire                                     202  
                           Department of  
                         Revenue Administration                 DP-10-ES

                                                  ESTIMATED INTEREST AND DIVIDENDS TAX  

                                            Taxpayer's Worksheet - Keep This Page For Your Records

1   All interest and dividend income subject to tax under RSA 77

2   Less Exemption(s) – check the exemption(s) that apply (see instructions):

    2(a) Yourself          Spouse           Partnership/LLC     Estate           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(c)  Total exemptions (Line 2(a) plus 2(b))

3   New Hampshire Taxable Income (Line 1 minus Line 2(c))

4   New Hampshire Interest and Dividends Tax (Line 3 multiplied by  %)

    If Line 4 is less than $500, see instructions 

5  RSA 77-G Education Tax Credit 
6  OVERPAYMENT from previous taxable period (If the overpayment exceeds the first 1/4 installment, the overage will 
     be applied to the next consecutive installment(s) until fully depleted)
7   BALANCE OF ESTIMATED INTEREST AND DIVIDENDS TAX (Line 4 minus Lines 5 and 6)

                                             COMPUTATION AND RECORD OF PAYMENTS
         Date Paid               Amount of Each Installment         Overpayment and Credit         Balance Due                    Calendar Year  
                                            (1/4 of Line 4)                 Applied to Installment                                Due Dates

                                                                                                                                  April 15, 202 

                                                                                                                                  June 15, 202 

                                                                                                                                  Sept. 15, 202 

                                                                                                                                  Jan. 15, 202 

                                 IMPORTANT 
Enter the primary taxpayer and spousal information in the same 
    order on all tax documents to avoid delays in processing.                                       MAKE YOUR PAYMENTS ONLINE 
                                                                                                    AT GRANITE TAX CONNECT   
    THE PENALTY PROVISIONS OF RSA 21-J:32 WILL APPLY IF THE                                        www.revenue.nh.gov/gtc
         ESTIMATE REQUIREMENTS HAVE NOT BEEN MET

         DP-10-ES  202  
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                           New Hampshire                      202  
                           Department of                                                        *DP10ES2411862*
                          Revenue Administration              DP-10-ES                           DP10ES2411862

                                               ESTIMATED INTEREST AND DIVIDENDS TAX 

For the CALENDAR year 202  or other taxable period beginning: 
                                                                       ENTITY TYPE - Check One
MMDDYYYY                            MMDDYYYY
                                   and ending:                              1 - Individual/Joint            3 - Partnership/LLC       4 - Estate

Last Name                                                                                                    If issued a DIN, use the DIN in 
                                                                                                             the appropriate taxpayer 
                                                                                                             identification box. 
                                                                                                             DO NOT enter SSN or FEIN
First Name                                         MI         Social Security Number

                                                                                                             Taxpayer Identification Number

Spouse's Last Name

First Name                                         MI         Social Security Number

Name of Partnership, Estate, or LLC

Number & Street Address

Address (continued)

City / Town                                                           State                     Zip Code + 4 (or Canadian Postal Code)
                                                                       
                                                   DO NOT CUT.  SUBMIT THIS ENTIRE PAGE.
                            MAKE YOUR PAYMENTS ONLINE AT                                                     Payment Form 1
                   GRANITE TAX CONNECT www.revenue.nh.gov/gtc                                   Amount of 
                                                                                                This Payment
Or mail to:                         Make Check Payable to:  STATE OF NEW HAMPSHIRE  
NH DRA                                         Enclose, but do not staple or tape your payment              Do not file a $0 estimate
PO Box 1265                                        to this estimate.  
Concord NH 03302-1265

        DP-10-ES  202  
        Version     0 /202 

                         New Hampshire                        202  
                         Department of                                              *DP10ES2411862*
                        Revenue Administration                DP-10-ES                           DP10ES2411862

                                               ESTIMATED INTEREST AND DIVIDENDS TAX  

For the CALENDAR year 202  or other taxable period beginning: 
                                                                       ENTITY TYPE - Check One
MMDDYYYY                            MMDDYYYY
                                   and ending:                              1 - Individual/Joint            3 - Partnership/LLC       4 - Estate

Last Name                                                                                                    If issued a DIN, use the DIN in 
                                                                                                             the appropriate taxpayer 
                                                                                                             identification box. 
                                                                                                             DO NOT enter SSN or FEIN
First Name                                         MI         Social Security Number

                                                                                                             Taxpayer Identification Number

Spouse's Last Name

First Name                                         MI         Social Security Number

Name of Partnership, Estate, or LLC

Number & Street Address

Address (continued)

City / Town                                                           State                     Zip Code + 4 (or Canadian Postal Code)
                                                                       
                                                   DO NOT CUT.  SUBMIT THIS ENTIRE PAGE.
                         MAKE YOUR PAYMENTS ONLINE AT                                                        Payment Form 2
                    GRANITE TAX CONNECT www.revenue.nh.gov/gtc                                  Amount of 
Or mail to:                                                                                     This Payment
                                    Make Check Payable to:  STATE OF NEW HAMPSHIRE                           Do not file a $0 estimate
NH DRA                                         Enclose, but do not staple or tape your payment  
PO Box 1265                                        to this estimate.  
Concord NH 03302-1265

        DP-10-ES  202  
        Version 1 0 /202 

                     New Hampshire                            202  
                       Department of                                        *DP10ES2411862*
                    Revenue Administration                    DP-10-ES                           DP10ES2411862

                                               ESTIMATED INTEREST AND DIVIDENDS TAX  

For the CALENDAR year 202  or other taxable period beginning: 
                                                                       ENTITY TYPE - Check One
MMDDYYYY                            MMDDYYYY
                                   and ending:                              1 - Individual/Joint            3 - Partnership/LLC       4 - Estate

Last Name                                                                                                    If issued a DIN, use the DIN in 
                                                                                                             the appropriate taxpayer 
                                                                                                             identification box. 
                                                                                                             DO NOT enter SSN or FEIN
First Name                                         MI         Social Security Number

                                                                                                             Taxpayer Identification Number

Spouse's Last Name

First Name                                         MI         Social Security Number

Name of Partnership, Estate, or LLC

Number & Street Address

Address (continued)

City / Town                                                           State                     Zip Code + 4 (or Canadian Postal Code)
                                                                       
                                                   DO NOT CUT.  SUBMIT THIS ENTIRE PAGE.
                       MAKE YOUR PAYMENTS ONLINE AT                                                          Payment Form 3
                GRANITE TAX CONNECT www.revenue.nh.gov/gtc                                      Amount of 
                                                                                                This Payment
Or mail to:                         Make Check Payable to:  STATE OF NEW HAMPSHIRE                           Do not file a $0 estimate
NH DRA                                         Enclose, but do not staple or tape your payment  
PO Box 1265                                        to this estimate.  
Concord NH 03302-1265

    DP-10-ES  202  
    Version 1 0 /202 

                         New Hampshire                        202  
                         Department of                                                 *DP10ES2411862*
                        Revenue Administration                DP-10-ES                                     DP10ES2411862

                                               ESTIMATED INTEREST AND DIVIDENDS TAX 

For the CALENDAR year 202  or other taxable period beginning: 
                                                                                 ENTITY TYPE - Check One
MMDDYYYY                            MMDDYYYY
                                   and ending:                                        1 - Individual/Joint  3 - Partnership/LLC       4 - Estate

                                                                                                             If issued a DIN, use the DIN in 
Last Name                                                                                                    the appropriate taxpayer 
                                                                                                             identification box. 
                                                                                                             DO NOT enter SSN or FEIN
First Name                                         MI         Social Security Number

                                                                                                             Taxpayer Identification Number

Spouse's Last Name

First Name                                         MI         Social Security Number

Name of Partnership, Estate, or LLC

Number & Street Address

Address (continued)

City / Town                                                                     State           Zip Code + 4 (or Canadian Postal Code)
                                                                                 
                                                   DO NOT CUT.  SUBMIT THIS ENTIRE PAGE.
                          MAKE YOUR PAYMENTS ONLINE AT                                                       Payment Form 4
                    GRANITE TAX CONNECT www.revenue.nh.gov/gtc                                  Amount of 
Or mail to:                                                                                     This Payment
                                    Make Check Payable to:  STATE OF NEW HAMPSHIRE  
NH DRA                                         Enclose, but do not staple or tape your payment               Do not file a $0 estimate
PO Box 1265                                                  to this estimate.  
Concord NH 03302-1265

        DP-10-ES  202  
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                      New Hampshire                                   202             ESTIMATED INTEREST AND 
                      Department of  
                     Revenue Administration                  DP-10-ES                 DIVIDENDS TAX  

                                                                   INSTRUCTIONS
Who Must Pay Estimated Tax 
Every taxpayer required to file an Interest and Dividends Tax Return must also make estimated Interest and Dividends Tax payments for its subsequent taxable period, 
unless the annual estimated tax for the subsequent taxable period is less than $500. See “Exceptions to the Underpayment of Estimated Tax Penalty” below. 
Note: For taxable periods ending on or after December 31, 2013, interest and dividends income shall be taxed as follows: 
     • Income received by estates held by trustees treated as grantor trusts under Section 671 of the United States Internal Revenue Code shall be 
     included in the return of their grantor, to the extent that the grantor is an inhabitant or resident of New Hampshire. 
     • Income reported by, and taxed federally as interest or dividends to, a trust beneficiary shall be included as interest or dividends in the return of 
     such beneficiary, to the extent that the beneficiary is an inhabitant or resident of New Hampshire with respect to distributions from a trust not 
     treated as a grantor trust under 671 of the United States Internal Revenue Code. 

Where to Make Payments 
Make estimated tax payments online at Granite Tax Connect www.revenue.nh.gov/gtc or mail to NH DRA, PO Box 1265, Concord NH 03302-1265. 

When to Make Payments  Note: If the 15th falls on a Saturday, Sunday, or legal holiday, the estimated tax payment is due on the next business day. 
               CALENDAR YEAR FILERS: 
                1st quarterly estimated tax payment due April 15, 202 
                2nd quarterly estimated tax payment due June 15, 202  
                3rd quarterly estimated tax payment due September 15, 202  
                4th quarterly estimated tax payment is due January 15, 202  
               FISCAL YEAR FILERS: 
                Quarterly estimated tax payments are due on or before the 15th day of the 4th, 6th, 9th and 12th     
                months of the taxable period to which they relate. 

Payment of Estimated Tax 
Estimated tax may be paid in full with the initial declaration, or in installments on the required due dates. If paying in full, only one payment form is required. By utilizing 
Granite Tax Connect at www.revenue.nh.gov/gtc, you may authorize the Department of Revenue Administration to automatically withdraw estimate payments from 
your account electronically. Simply specify each date for which you would like a payment to be withdrawn from your account and each payment will be withdrawn on 
those dates. 
Joint filers: Enter the primary taxpayer and spousal information in the same order on all tax documents to avoid delays in processing. 

Underpayment of Estimated Tax Penalty 
A penalty may be imposed pursuant to RSA 21-J:32 for any underpayment of estimated tax if the payments are less than 90% of the current tax period's tax liability. If 
estimate payments are not made by the statutory due date, even if 90% of the tax is eventually paid, an underpayment penalty may be assessed. If an estimated 
payment is missed, send the payment as soon as possible to reduce any penalty. This penalty will not be imposed if any of the statutory exceptions are met.  

Exceptions to the Underpayment of Estimated Tax Penalty 
The underpayment of estimated tax penalty shall not apply if you meet one of the exceptions provided in RSA 21-J:32. Use Form DP 2210/2220 to determine whether 
you have met one of the exceptions, or to compute the amount of the penalty associated with the underpayment of estimated tax. This form may be obtained from our 
website at www.revenue.nh.gov or by calling the Forms Line at (603) 230-5001. 

Need Help? 
Questions not covered here may be answered in our “Frequently Asked Questions” available on our website at www.revenue.nh.gov or by calling Taxpayer Services at 
(603) 230-5920, Monday through Friday, 8:00 am to 4:30 pm. All written correspondence to the Department should include the taxpayer name, taxpayer identification 
number, the name of a contact person, and a daytime telephone number. Individuals who need auxiliary aids for effective communications in programs and services of 
the New Hampshire Department of Revenue Administration are invited to make their needs and preferences known. Individuals with hearing or speech impairments 
may call TDD Access: Relay NH 1-800-735- 2964. 

     DP-10-ES  202  
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