Print Form                                                 Reset Form
                     New Hampshire  
                         Department of  
                                                            DP-200          *0DP2002311862*
              Revenue Administration
                                                                                                 0DP2002311862

                                REQUEST FOR DEPARTMENT IDENTIFICATION NUMBER (DIN)

BUSINESS ENTITY INFORMATION
 Business Name
 QUALES INN 
 Number & Street Address                                                                              DO NOT FILE THIS FORM FOR AN SMLLC 
 678 AUTUMN DR                                                                                                             THAT ALREADY HAS ITS OWN FEIN
 City / Town                                   State    Zip Code + 4 (or Canadian Postal Code)
 MANCHESTER                                    NH           0 3 1   0   4 - 1 2            3  4
You must use your Department Identification Number (DIN) on all of the documents filed with the DRA instead of the Federal Employer Identification Number (FEIN) or 
Social Security Number (SSN).

MEMBER OR TAXPAYER INFORMATION
 Member or Taxpayer Name                                                                         Taxpayer Identification Number
 JOHN KERRY                                                                                        2  3                                4 2   3  4 2  3       4
 Number & Street Address                                                                                                                   FEIN SSN
 689 GRANITE RD 
 City / Town                                   State    Zip Code + 4 (or Canadian Postal Code)
 CONCORD                                       NH           0 3 3   0   1

ENTITY TYPE:   CORPORATION           COMBINED GROUP           FIDUCIARY     PARTNERSHIP               PROPRIETORSHIP

 For federal income tax purposes, the income of the SMLLC will be reported on the tax return of the member as listed above.
 For federal income tax purposes, the income of the SMLLC will NOT be reported on the tax return of the member as listed above.  

 THE INCOME WILL BE REPORTED ON THE TAX RETURN FOR:
 Member or Taxpayer Name                                                                         Taxpayer Identification Number
 KYLER SUTTER                                                                                      7  7                                7 6   4  8 7  9       8
 Number & Street Address
                                                                                                                                           FEIN   SSN
 777 MAHON ST 
 City / Town                                   State    Zip Code + 4 (or Canadian Postal Code)
 CONCORD                                       NH           0 3 3   0   1 - 1 2            3  4

SIGNATURE & INFORMATION
Under penalties of perjury, I declare that I have examined this document and to the best of my belief it is true, correct and complete.
Signature (in ink) of Applicant                                                               MMDDYYYY
                                                                                               1 1 2  1 2                                0 2 3

Print Signatory Name & Title
 JOHN KERRY 

                                FILE ONLINE AT GRANI TE TAX CONNECT WWW.REVENUE.NH.GOV/GTC      OR 
                                     MAIL TO: NH DRA, PO BOX 637, CONCORD NH 03302-0637

 DP-200
 Version 1   08/2023                                                                                                                              Page 1 of 2

                          New Hampshire  
                          Department of  
                                                          DP-200                          INSTRUCTIONS
                    Revenue Administration

WHO MUST REQUEST A DIN 
Any taxpayer who shares a taxpayer identification number with another taxpayer subject to taxation, any taxpayer who is not 
required to obtain a federal taxpayer identification number or Social Security Number. Each taxpayer must have a unique federal 
or state taxpayer identification number. A SMLLC shall not use an SSN. 

PURPOSE 
To obtain an identifying number which is required to file New Hampshire tax related documents. SMLLCs are required by New 
Hampshire Law to file a separate entity tax return even though the SMLLC does NOT file a separate federal tax return. If the SMLLC 
shares a tax identification number with another entity, a New Hampshire Department Identification Number (DIN), is necessary in 
order to process all tax related documents for taxpayers as described in "Who Must Request a DIN" above. 

WHEN TO FILE 
This form must be filed at least 30 days prior to the due date of your first business tax document. Any changes in the registration 
information must be provided to the Department at least 30 days prior to the change. 

WHERE TO FILE 
File online at Granite Tax Connect www.revenue.nh.gov/gtc or mail forms to the New Hampshire Department of Revenue 
Administration, Taxpayer Services Division, PO Box 637, Concord, NH 03302-0637. 

NEED HELP? 
Call the Department of Revenue Administration, Taxpayer Services at (603) 230-5920. Individuals with hearing or speech 
impairments may call TDD Access:  Relay NH 1-800-735-2964.

                                    FORMS SHALL NOT BE FILED BY FAX OR EMAIL 

     DP-200
     Version 1    08/2023                                                                                              Page 2 of 2