New Hampshire                                  CD-3
                                  Department of                Application for  
                   Revenue Administration                 Meals & Rentals Tax 
                                                                                                 *000CD31911862*
                                                           Operators License                                       000CD31911862

                                                 LICENSE REQUIRED BEFORE OPERATING
TYPE OR PRINT CLEARLY
   Business Name (DBA)

1.
   Mailing Address                                                                                              Secretary of State Business ID#

2.
   Mailing Address (continued)                                                                   E-Mail Address 

3.                                                                                            4.
   City / Town                                                        State               Zip Code + 4 (or Canadian Postal Code)
                                                                       
5.

6(a). Type of Business Entity:           1- Proprietorship         2- Corporation             3- Partnership           4- Fiduciary        5- Non-Profit

6(b). Is the Business Entity an LLC?         Yes  No

      Name of Owner/Entity
6(c).

7. Federal Employer Identification Number of the owner:        FEIN:                                            (Do not enter SSN here)

8. If NH business taxes are filed under an SSN or a different FEIN or DIN enter below: 
              FEIN               SSN                                             or   DIN:

9. List All Individual Owners, Partners, LLC Managers and Members, or Corporate Officers, and Any Other Person in a Managerial Capacity (if more 
  space is needed, attach additional sheets):
      Last Name                                           First Name                                            MI        Title
9(a).
      Residence Address - No PO Boxes                                                            Social Security Number

      City / Town                                              State        Zip Code + 4 (or Canadian Postal Code)        Phone Number
                                                                
      Last Name                                           First Name                                            MI        Title
9(b).
      Residence Address - No PO Boxes                                                            Social Security Number

      City / Town                                              State        Zip Code + 4 (or Canadian Postal Code)        Phone Number
                                                                
      Last Name                                           First Name                                            MI        Title
9(c).
      Residence Address - No PO Boxes                                                            Social Security Number

      City / Town                                              State        Zip Code + 4 (or Canadian Postal Code)        Phone Number
                                                                    
              CD-3 
              Version 1.7 10/2019    Mail To: NH DRA, COLLECTIONS DIVISION, PO BOX 637, CONCORD, NH 03302-0637                                 Page 1 of 2

                          New Hampshire               CD-3
                          Department of               Application for  
                Revenue Administration                Meals & Rentals Tax                *000CD31921862*
                                                       Operators License                                        000CD31921862

    Contact Person Last Name                        Contact Person First Name         Title                          Phone Number

10.
    Business Telephone Number              Physical Business Address in NH 
11.                                     12.
    City / Town                                       State                           Zip Code + 4 
                                                       
    Proposed Opening Date                     Type of Business Activity
13.                                        14.

15. Check here if you serve:    Food           Alcoholic Beverages     Number of Seats in Restaurant and/or Lounge

16. Indicate if you rent:     Sleeping Accommodations Number of Rooms

                              Function Rooms          Number of Rooms

                              Motor Vehicles          Number of Vehicles
                                                                                                     Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
17. Check here if you are requesting permission to file returns as a season filer:    Specify months:

    NH Banking Institution of the Owner                                               Account Holder's Full Name
18.                                                                                19.

20. Consolidated Return
    Operators having more than one license may request permission to file on a consolidated basis provided all licenses use the same Federal 
    Employer Identification Number. Operators must designate one license number to be the master (primary) license number and provide the 
    business name, address, and Meals & Rentals License Number of each member of the group.
20(a). Are you requesting to be a member of a consolidated Meals & Rentals filing group?              Yes  No
       If yes, specify master (primary) license number

20(b). Are you requesting to be a master (primary) filer for a consolidated Meals & Rentals filing group?        Yes  No
       If yes, attach a list indicating members' Meals & Rentals licenses, business names, & addresses.

Complete pages 1 and 2 and submit to the NH Department of Revenue Administration 

I declare under penalties of perjury that I am authorized to sign on behalf of the owner applying for a license, that I have examined all of the 
information provided on or with this application, and that the information is true, correct, and complete to the best of my knowledge and belief. 
Signature (in ink) of Owner/Operator From Line 9(a)                                                  MMDDYYYY

Signature (in ink) of Owner/Operator From Line 9(b)                                                  MMDDYYYY

Signature (in ink) of Owner/Operator From Line 9(c)                                                  MMDDYYYY

       CD-3 
       Version 1.7 10/2019
                             Mail To: NH DRA, COLLECTIONS DIVISION, PO BOX 637, CONCORD, NH 03302-0637