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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
TUFT                                                                                                                         Due Date for FISCAL year 
First Name                                             MI         Social Security Number                               filers is the 15th day of the 
                                                                                                                             4th month after  
JEREMY                                                 A          0      2 0 1 4     5   1 4 6                               the close of the  
                                                                                                                             taxable period.
Spouse's Last Name
                                                                                                                       If you have a DIN, use the DIN 
                                                                                                                             in the taxpayer ID box. 
                                                                                                                             DO NOT use FEIN or SSN
First Name                                             MI         Social Security Number                              Taxpayer Identification Number

Name of Partnership, Estate, or LLC

Number & Street Address
1212 CIRCLE TURNPIKE
Address (continued)                                                                                                   Unit Type                            Unit #
                                                                                                                        
City / Town                                                                  State       Zip Code + 4 (or Canadian Postal Code)
LONDONDERRY                                                                  NH          0 3 0 5 3

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     7      1 7      2   0 2 1    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            2 4 0 0

7     Adjusted Taxable Income (Line 5 minus Line 6) If less than zero, use minus sign.                     7                        1 2          7 3 0 0

                                                                                      Year of Birth                                 Year of Birth
       Blind                Spouse Blind           65 (or over) or disabled           1 9 5 2       Spouse 65 (or over) or disabled 

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          4 9 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      9                6
           (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      9                6
     Credit (Line 10 minus Line 11.  If negative enter zero) 

13     Payments:  
           (a) Tax paid with application for extension                          13(a)                 7     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)                                                8 5      0                0

14     Subtotal Due (Line 12 minus Line 13 Subtotal)                                                                           14  - 4 1 0                     4

15    Additions to Tax: 
           (a) Interest                                                        15(a)                  1 5     0 0

           (b) Failure to Pay                                                  15(b)

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

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

STEP 5  -  Calculate Your Net Balance Due or Overpayment

16        (a) Subtotal Due (Line 14 plus Line 15 Subtotal)                      16(a) -               2     6 0 4

           (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   

18    OVERPAYMENT  
            (If balance due is less than zero, enter on Line 18)       18                             2     6 0 4
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                           2 6      0                4

           (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
                                                                                      0 6 1 5           2 0 2 3
If joint return, BOTH parties must sign, even if only one had income                  MMDDYYYY

Print Signatory Name(s) (and Title if applicable)
JEREMY TUFT
Taxpayer's Phone Number
6 0  3      2   3    0    5 0 5 4                  Filing as surviving spouse         Form 1310 attached

PAID PREPARER'S SIGNATURE & INFORMATION
Signature of Preparer                                                                 MMDDYYYY
                                                                                      0 6 1 5 2           0 2 3
Printed Name of Preparer
COLE WARREN
Preparer's Phone Number                          Preparer Identification Number
6 0  3      5     2  6    4 4 1 1                P 1 2 1 6           5 4 8     9
Preparer's Address
120 PLEASANT ST APT 11
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