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                  New Hampshire                                 202 3
                       Department of                                                     *00DP102311862*
                                                                DP-10
                  Revenue Administration                                                                        00DP102311862

                                                 INTEREST AND DIVIDENDS TAX RETURN

                                                                MMDDYYYY                               MMDDYYYY
For the CALENDAR year 202  3 or other taxable period beginning: 0 1 0    1 2    0  2 3     and ending:          1 2 3 1 2    0   2     3

STEP 1  -  PRINT OR TYPE                           Check box if there has been a name change since last filing.              Due Date for CALENDAR 
Last Name                                                                                                                    year filers is on or before  
                                                                                                                             April 15, 202 4
DAY                                                                                                                          Due Date for FISCAL year 
First Name                                             MI         Social Security Number                               filers is the 15th day of the 
                                                                                                                             4th month after  
EMILY                                                  L          6      5 2 6     2 2   5 5 4                               the close of the  
                                                                                                                             taxable period.
Spouse's Last Name
                                                                                                                       If you have a DIN, use the DIN 
DAY                                                                                                                          in the taxpayer ID box. 
                                                                                                                             DO NOT use FEIN or SSN
First Name                                             MI         Social Security Number                              Taxpayer Identification Number
AARON                                                  M          6      5 4 5     4 5   4 8 4

Name of Partnership, Estate, or LLC

Number & Street Address
72 S MAIN ST
Address (continued)                                                                                                   Unit Type                            Unit #
                                                                                                                      Apartment                            2

City / Town                                                                  State         Zip Code + 4 (or Canadian Postal Code)
DURHAM                                                                       NH            0 3 8 2 4                - 1 2 6 5

STEP 2  -  Return Type
                                                                                             % of NEW HAMPSHIRE Ownership 
ENTITY TYPE - Check One                                                                      Interest in Entity Type
    1 - INDIVIDUAL                 1 - JOINT         3 - PARTNERSHIP/LLC   4 - ESTATE

                       MMDDYYYY                                                                                 Date of Death
    INITIAL RETURN     0     2      1 8      2   0 2 0    Established NH Residency   FINAL DECEASED

                       MMDDYYYY                                                                                 Social Security Number 
    FINAL RETURN                                          Abandoned NH Residency

    AMENDED RETURN                  IRS ADJUSTMENT: A complete federal Revenue Agent Report (RAR) with all applicable Schedules must be included with a complete amended NH 
                                    tax return.  Do not use this form to report  IRS adjustments for taxable periods ending on or before December 31, 2020.

    DP-10 202  3                                                                                                                        Page 1 of 5
    Version 1.1 11/2023

                            New Hampshire                                   202 3
                                 Department of                                                          *00DP102321862*
                                                                            DP-10
                            Revenue Administration                                                                           00DP102321862

                                             INTEREST AND DIVIDENDS TAX RETURN - continued

STEP 3  -  Read instructions before you begin

                                                        INTEREST & DIVIDENDS FROM ALL SOURCES                                               Round to the nearest whole dollar
1      From Your Federal Income Tax Return: (See Instructions) 
       (a) Interest Income. Enter the amount from Line 2(b) of your federal return                                         1(a)                  1 2 4 0            0        0

       (b) Dividend Income. Enter the amount from Line 3(b) of your federal return                                         1(b)                      5 7            0        0

       (c) Federal Tax-Exempt Interest Income. Enter the amount from Line 2(a) of your federal return                      1(c)

       (d) Subtotal Interest and Dividends Income. (Sum of Lines 1(a), 1(b) and 1(c))                                  Subtotal    1(d)          1 2 9 7            0        0

2      List Taxable Annuities or Actual Cash & Property Distributions From S-Corporations, Trusts/Estates, Partnerships, and LLCs: 
       Entity Codes:     2 = S-CORPORATIONS;     3 = PARTNERSHIPS;       =4 TRUSTS OR ESTATES;       =5 LLC;       = FOUNDATIONS;      6 = OTHER7
       I                                                II                                                             III                       IV 
Entity Code                                          Name of Payor                                                 Payor's ID Number             Distribution Amount

                                                                                      Total from supplemental schedule attached

2      Total Distributions (Sum of Column IV above)                         2

3      Subtotal Gross Interest and Dividends Income and Distributions (Line 1(d) plus Line 2)                              Subtotal    3         1 2 9 7            0        0

4      List payors and amounts of interest and/or dividends NOT TAXABLE to New Hampshire included on Lines 1(a), 1(b), 1(c) and/or 2:  
       I                                                II                                                             III                       IV 
Reason Code                                          Name of Payor                                                 Payor's ID Number             Non-Taxable Amount

       (a) Subtotal of non-taxable income above (Sum of Column IV)          4(a)

       (b) Total non-taxable income from supplemental schedule (Attached)   4(b)

       (c) Non-taxable income (Subtotal of Lines 4(a) plus 4(b))            4(c)

       (d) Part-year resident non-taxable income pro rata share             4(d)

            DP-10 202  3                                                                                                                           Page 2 of 5
            Version 1  .1 11/2023

                       New Hampshire                               202 3
                            Department of                                                           *00DP102331862*
                                                                   DP-10
                       Revenue Administration                                                                   00DP102331862

                                         INTEREST AND DIVIDENDS TAX RETURN - continued
STEP 3  -  (continued)  Read instructions before you begin

                                                   INTEREST & DIVIDENDS FROM ALL SOURCES                        Round to the nearest whole dollar
4      Total Non-Taxable Income (Sum of Line 4(c) plus Line 4(d))                                              4

5      Gross Taxable Income (Line 3 minus Line 4)                                                         5                         1   2         9 7 0 0

6      Less: $2,400 for Individual, Partnership and Estate; $4,800 for Joint filers                                                 6             4 8 0 0

7     Adjusted Taxable Income (Line 5 minus Line 6) If less than zero, use minus sign.                     7                        1   2         4 9 0 0

                                                                                      Year of Birth                                 Year of Birth
       Blind                Spouse Blind           65 (or over) or disabled           1 9 4 2       Spouse 65 (or over) or disabled 1 9 4        4

8       Check the exemptions that apply.    Total number of boxes checked             2 x $1200 =             8                                   2 4 0 0

9      Net Taxable Income (Line 7 minus Line 8). If less than zero, use minus sign.                        9                        1   2         2 5 0 0

       DP-10 202  3                                                                                                                     Page 3 of 5
       Version 1  .1 11/2023

                           New Hampshire                                 202 3
                                  Department of                                                       *00DP102341862*
                                                                         DP-10
                           Revenue Administration                                                                   00DP102341862

                                                  INTEREST AND DIVIDENDS TAX RETURN - continued

STEP 4  -  Calculate Your Tax, Credits, Interest and Penalties                                                                     Round to the nearest whole dollar

10     New Hampshire Interest and Dividends Tax                                                                                 10 4 9        0                0
           (Line 9 multiplied by 4%) 

11      RSA 77-G Education Tax Credit                                           11                              6 0 0

12    New Hampshire Interest and Dividends Tax Net of Education Tax                                                            12  4 3        0                0
     Credit (Line 10 minus Line 11.  If negative enter zero) 

13     Payments:  
           (a) Tax paid with application for extension                          13(a)                 1 0     0 0

           (b) Current year estimated tax payments                              13(b)                       5 0 0

           (c) Credit carryover from prior tax period                           13(c)                 1 0     0 0
                                                                                                                     13   Subtotal of Lines 13(a) through 13(d)

           (d) Paid with original return (Amended returns only)                 13(d)                                              2 5        0                0

14     Subtotal Due (Line 12 minus Line 13 Subtotal)                                                                           14  1 8        0                0

15    Additions to Tax: 
           (a) Interest                                                        15(a)                        5 2 0

           (b) Failure to Pay                                                  15(b)                        2 5 5

           (c) Failure to File                                                 15(c)                        8 3 0
                                                                                                                    15   Subtotal of Lines 15(a) through 15(d)

           (d) Underpayment of Estimated Tax                                   15(d)                                               1 6        0                5

STEP 5  -  Calculate Your Net Balance Due or Overpayment

16        (a) Subtotal Due (Line 14 plus Line 15 Subtotal)                      16(a)                 3     4 0 5

           (b) Return Payment Made Electronically                                                                 16(b)

17    Net Balance Due (Line 16(a) minus Line 16(b))  
            (Make Check Payable to State of New Hampshire)                                            17    PAY THIS AMOUNT        3 4        0                5

18    OVERPAYMENT  
            (If balance due is less than zero, enter on Line 18)       18
19    Amount of Line 18 to be applied to: 
           (a) Credit - Next Year's Tax Liability (Not available for Federal RAR)     19(a)   DO NOT PAY

           (b) Refund (Only option available for Federal RAR)                            19(b)   DO NOT PAY 

           DP-10 202  3                                                                                                            Page 4 of 5
           Version 1  .1 11/2023

                     New Hampshire                                   202 3
                            Department of                                             *00DP102351862*
                                                                     DP-10
                     Revenue Administration                                                             00DP102351862

                                  INTEREST AND DIVIDENDS TAX RETURN - continued
Under penalties of perjury, I declare that I have examined this return and to the best of my belief it is true, correct and complete. If 
prepared by a person other than the taxpayer, this declaration is based on all information of which the preparer has knowledge.

     POA:  By checking this box and signing below, you authorize us to discuss this return with the preparer listed below.

TAXPAYER'S SIGNATURE & INFORMATION
Signature (in ink)                                                                    MMDDYYYY
                                                                                      1 2 1 9           2 0 2 3
If joint return, BOTH parties must sign, even if only one had income                  MMDDYYYY
                                                                                      1 2 1 9           2 0 2 3
Print Signatory Name(s) (and Title if applicable)
EMILY DAY AARON DAY
Taxpayer's Phone Number
6 0  3      5      2 0    5 5 2 2                    Filing as surviving spouse       Form 1310 attached

PAID PREPARER'S SIGNATURE & INFORMATION
Signature of Preparer                                                                 MMDDYYYY
                                                                                      1 2 1 4 2           0 2 3
Printed Name of Preparer
ERIC GOSS
Preparer's Phone Number                          Preparer Identification Number
6 0  3      5      6 6    5 5 4 4                1 5 6 4 8           4 1 5     6
Preparer's Address
72 SOUTH ST
City / Town                                                                     State Zip Code + 4 (or Canadian Postal Code)
CONCORD                                                                         NH    0 3 3 0 1

Mail to:                          Make Check Payable to:   
                                                                                      FILE ONLINE AT GRANITE TAX CONNECT 
NH DRA                            STATE OF NEW HAMPSHIRE 
                                                                                          www.revenue.nh.gov/gtc
PO Box 637                      Enclose but DO NOT staple or tape your 
Concord NH 03302-0637                            attachments

     DP-10 202  3                                                                                                           Page 5 of 5
     Version 1  .1 11/2023