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                                         New Hampshire                     202  
                                         Department of                       4
                                        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                                                                       9 9 0         5  0
2   Less Exemption(s) – check the exemption(s) that apply (see instructions):

    2(a) Yourself                        Spouse Partnership/LLC     Estate      Total number of boxes checked       2   x $2400 = 2(a)               4 8 0 0
    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))                                                                                             4 8          0 0

3   New Hampshire Taxable Income (Line 1 minus Line 2(c))                                                                              9 4 2          5 0

4   New Hampshire Interest and Dividends Tax (Line 3 multiplied by 3 %)                                                                  2 8          2 8

    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)                                                               5          0 0

7   BALANCE OF ESTIMATED INTEREST AND DIVIDENDS TAX (Line 4 minus Lines 5 and 6)                                                         2 3          2 8

                                                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

    1 0  1 3 2 0 2 3                                            7 0 7            1 2 5                                5 8 2            April 15, 2024

    1 0 2 0 2 0 2 3                                             7 0 7            1 2 5                                5 8 2            June 15, 2024

    1 0 2 7 2 0 2 3                                             7 0 7            1 2 5                                5 8 2            Sept. 15, 2024

    1 1 0 3 2 0 2 3                                             7 0 7            1 2 5                                5 8 2            Jan. 15, 2025

                                         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

         VersionDP-10-ES 1 0202 7 /2024 3

                                                                                                                           Print This Page

                                       New Hampshire                202  
                                          Department of                    4                             *DP10ES2411862*
                                      Revenue Administration     DP-10-ES
                                                                                                               DP10ES2411862
                                                        ESTIMATED INTEREST AND DIVIDENDS TAX 

For the CALENDAR year 202  4 or other taxable period beginning:                       ENTITY TYPE - Check One
MMDDYYYY                                    MMDDYYYY
                                            and ending:                                  1 - Individual/Joint             3 - Partnership/LLC      4 - Estate
0 1 0       1 2                       0 2 4             1 2 3 1 2 0 2  4

Last Name                                                                                                                  If issued a DIN, use the DIN in 
                                                                                                                           the appropriate taxpayer 
SMITH                                                                                                                      identification box. 
                                                                                                                           DO NOT enter SSN or FEIN
First Name                                                    MI    Social Security Number
JONATHAN                                                      G        2   3     4 5  6  7               8 9 0             Taxpayer Identification Number

Spouse's Last Name
SMITH
First Name                                                    MI    Social Security Number
JANE                                                          D        9   8     7 6  5  4               3 2 1

Name of Partnership, Estate, or LLC

Number & Street Address
804 PINECREST DR 
Address (continued)
UNIT 6 
City / Town                                                                        State                   Zip Code + 4 (or Canadian Postal Code)
HANOVER                                                                            NH                      0 3 7 5 5 -     1 2 3 4
                                                              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                        5 8   2
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

     Version  DP-10-ES 1 7 0202 /2024 3

                                                                                                                        Print This Page

                                     New Hampshire                202  
                                        Department of                    4               *DP10ES2411862*
                                    Revenue Administration      DP-10-ES
                                                                                                             DP10ES2411862

                                                      ESTIMATED INTEREST AND DIVIDENDS TAX  

For the CALENDAR year 202  4 or other taxable period beginning:                     ENTITY TYPE - Check One
MMDDYYYY                                  MMDDYYYY
                                          and ending:                                  1 - Individual/Joint            3 - Partnership/LLC       4 - Estate
0 1 0       1 2                     0 2 4             1 2 3 1 2 0 2   4

Last Name                                                                                                               If issued a DIN, use the DIN in 
                                                                                                                        the appropriate taxpayer 
SMITH                                                                                                                   identification box. 
                                                                                                                        DO NOT enter SSN or FEIN
First Name                                                  MI    Social Security Number
JONATHAN                                                    D       2    3     4 5  6  7               8 9 0            Taxpayer Identification Number

Spouse's Last Name
SMITH
First Name                                                  MI    Social Security Number
JANE                                                        D       9    8     7 6  5  4               3 2 1

Name of Partnership, Estate, or LLC

Number & Street Address
804 PINECREST DR 
Address (continued)
UNIT 6 
City / Town                                                                      State                   Zip Code + 4 (or Canadian Postal Code)
HANOVER                                                                          NH                      0 3 7 5 5 -    1 2 3 4
                                                            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 
                                                                                                                                               5 8  2
  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

     VersionDP-10-ES 1 0202 7 /2024 3

                                                                                                                         Print This Page

                                     New Hampshire                202  
                                        Department of                    4             *DP10ES2411862*
                                    Revenue Administration      DP-10-ES
                                                                                                             DP10ES2411862

                                                      ESTIMATED INTEREST AND DIVIDENDS TAX  

For the CALENDAR year 202  4 or other taxable period beginning:                     ENTITY TYPE - Check One
MMDDYYYY                                  MMDDYYYY
                                          and ending:                                  1 - Individual/Joint             3 - Partnership/LLC      4 - Estate
0 1 0       1 2                     0 2 4             1 2 3 1 2 0 2 4

Last Name                                                                                                                If issued a DIN, use the DIN in 
                                                                                                                         the appropriate taxpayer 
SMITH                                                                                                                    identification box. 
                                                                                                                         DO NOT enter SSN or FEIN
First Name                                                  MI    Social Security Number
JONATHAN                                                    D       2    3     4 5  6  7               8 9 0             Taxpayer Identification Number

Spouse's Last Name
SMITH
First Name                                                  MI    Social Security Number
JANE                                                        D       9    8     7 6  5  4               3 2 1

Name of Partnership, Estate, or LLC

Number & Street Address
804 PINECREST DR 
Address (continued)
UNIT 6 
City / Town                                                                      State                   Zip Code + 4 (or Canadian Postal Code)
HANOVER                                                                          NH                      0 3 7 5 5 -     1 2 3 4
                                                            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                        5 8   2
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

     VersionDP-10-ES 1 0202 7 /2024 3

                                                                                                                        Print This Page

                                     New Hampshire                202  
                                        Department of                     4                *DP10ES2411862*
                                    Revenue Administration      DP-10-ES
                                                                                                               DP10ES2411862

                                                      ESTIMATED INTEREST AND DIVIDENDS TAX 

For the CALENDAR year 202  4 or other taxable period beginning:                        ENTITY TYPE - Check One
MMDDYYYY                                  MMDDYYYY
                                          and ending:                                     1 - Individual/Joint         3 - Partnership/LLC       4 - Estate
0 1 0       1 2                     0 2 4             1 2 3 1 2 0 2      4

                                                                                                                        If issued a DIN, use the DIN in 
Last Name                                                                                                               the appropriate taxpayer 
                                                                                                                        identification box. 
SMITH                                                                                                                   DO NOT enter SSN or FEIN
First Name                                                  MI    Social Security Number
JONATHAN                                                    D       2     3       4 5  6  7            8 9 0            Taxpayer Identification Number

Spouse's Last Name
SMITH
First Name                                                  MI    Social Security Number
JANE                                                        D       9     8       7 6  5  4            3 2 1

Name of Partnership, Estate, or LLC

Number & Street Address
804 PINECREST DR 
Address (continued)
UNIT 6 
City / Town                                                                         State                Zip Code + 4 (or Canadian Postal Code)
HANOVER                                                                             NH                   0 3 7 5 5 -    1 2 3 4
                                                            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 
                                                                                                                                               5 8   2
  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

     VersionDP-10-ES 1 0202 7 /2024 3

                                     New Hampshire                            202  
                                     Department of                                  4  ESTIMATED INTEREST AND 
                                    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, 2024
                        2nd quarterly estimated tax payment due June 15, 202 4
                        3rd quarterly estimated tax payment due September 15, 202 4
                        4th quarterly estimated tax payment is due January 15, 202 5
               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. 

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