DO NOT STAPLE

                            New Hampshire                       202  
                             Department of                                             *00DP102411862*
                                                                DP-10
                        Revenue Administration                                                               00DP102411862

                                                INTEREST AND DIVIDENDS TAX RETURN

                                                                MMDDYYYY                          MMDDYYYY
For the CALENDAR year 202    or other taxable period beginning:                        and ending:

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  
                                                                                                                          Due Date for FISCAL year 
First Name                                           MI         Social Security Number                         filers is the 15th day of the 
                                                                                                                          4th month after  
                                                                                                                          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

Address (continued)                                                                                           Unit Type                                   Unit #
                                                                                                                
City / Town                                                              State         Zip Code + 4 (or Canadian Postal Code)
                                                                          
STEP 2  -  R&563/ 5:1&
                                                                                 % of NEW HAMPSHIRE Ownership 
ENTITY TYPE - Check One                                                          Interest in Entity Type
        */%*7*%6"-           JOINT    PARTNERSHIP/LLC           ESTATE

                             MMDDYYYY                                                                        Date of Death
        INITIAL RETURN                                  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                                                                                                                                         Page 1 of 5
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                                New Hampshire                            202  
                                 Department of                                                        *00DP102421862*
                                                                         DP-10
                            Revenue Administration                                                                           00DP102421862

                                             INTEREST AND DIVIDENDS TAX RETURN - continued

STEP 3  -  R&"% */4536$5*0/4 #&'03& :06 #&(*/

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

       (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)

2      List Taxable Annuities or Actual Cash & Property Distributions From S-Corporations, Trusts/Estates, Partnerships, and LLCs: 
       Entity Codes:      = S-CORPORATIONS;      = PARTNERSHIPS;       = TRUSTS OR ESTATES;       = LLC;       = FOUNDATIONS;       = OTHER 
       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

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                                                                                                                          Page   of 5
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                           New Hampshire                           202  
                            Department of                                                           *00DP102431862*
                                                                   DP-10
                       Revenue Administration                                                                  00DP102431862

                                         INTEREST AND DIVIDENDS TAX RETURN - continued

STEP 3  -  3&"% */4536$5*0/4 #&'03& :06 #&(*/  DPOUJOVFE 

                                                   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

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

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

                                                                                      Year of Birth                                 Year of Birth
       Blind                Spouse Blind           65 (or over) or disabled                         Spouse 65 (or over) or disabled 

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

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

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                               New Hampshire                    202  
                                  Department of                                                    *00DP102441862*
                                                                DP-10
                           Revenue Administration                                                        00DP102441862

                                                INTEREST AND DIVIDENDS TAX RETURN - continued

STEP 4  -  C"-$6-"5& :063 5"9  $3&%*54  */5&3&454  "/% 1&/"-5*&4                                                           Round to the nearest whole dollar
10     New Hampshire Interest and Dividends Tax 
                                                                                                                    10
           (Line 9 multiplied by  %) 

11      RSA 77-G Education Tax Credit                                         11

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

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

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

           (c) Credit carryover from prior tax period                         13(c)
                                                                                                         13   Subtotal of Lines 13(a) through 13(d)
           (d) Paid with original return (Amended returns only)               13(d)

14     Subtotal Due (Line 12 minus Line 13 Subtotal)                                                                14

15    Additions to Tax: 
           (a) Interest                                                      15(a)

           (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)

STEP 5  -  C"-$6-"5& :063 /&5 #"-"/$& %6& 03 07&31":.&/5 
16        (a) Subtotal Due (Line 14 plus Line 15 Subtotal)                    16(a)

           (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  
      Refund POMZ                                                                  1        DO NOT PAY

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                         New Hampshire                               202  
                          Department of                                              *00DP102451862*
                                                                     DP-10
                     Revenue Administration                                                            00DP102451862

                             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

If joint return, BOTH parties must sign, even if only one had income                 MMDDYYYY

Print Signatory Name(s) (and Title if applicable)

Taxpayer's Phone Number
                                                 Filing as surviving spouse          Form 1310 attached

PAID PREPARER'S SIGNATURE & INFORMATION
Signature of Preparer                                                                MMDDYYYY

Printed Name of Preparer

Preparer's Phone Number                          Preparer Identification Number

Preparer's Address

City / Town                                                                    State Zip Code + 4 (or Canadian Postal Code)
                                                                                
Mail to:                     Make Check Payable to:   
                                                                                     FILE ONLINE AT GRANITE TAX CONNECT 
NH DRA                       STATE OF NEW HAMPSHIRE 
PO Box 637                   Enclose but DO NOT staple or tape your                  HUD SFWFOVF OI HPW 5"1 @ 
Concord NH 03302-0637                            attachments

     DP-10 202                                                                                                             Page   of 5
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