DO NOT STAPLE
                            New Hampshire  
                                Department of                             DP-139                                        *0DP1392411862*
              Revenue Administration                                                                                                    0DP1392411862

                             COMMUNICATIONS SERVICES TAX APPLICATION FOR REGISTRATION NUMBER
Owner/Company Name                                                                                                                      Taxpayer Identification Number

Business Name                                                                                                                                   FEIN                  SSN

Business Physical Location (Number & Street Address)                                                                                    Business Phone Number in NH:

City / Town                                                   State   Zip Code + 4 (or Canadian Postal Code)                            Corporate Headquarters Phone Number:
                                                               
Entity Type Check one of the following:
          Proprietorship        Corporation/Combined Group          Partnership            Fiduciary                    Non-Profit Organization

                                                              MMDDYYYY
Date you started selling communications services in NH:
Name and address of principal business location in NH:
Do you collect a Communications Services Tax for a reseller?          Yes                  No

If yes, for whom do you collect?
                                NAME & ADDRESS
Check the appropriate box or boxes below:
       "     We sell communications services from a location in NH at retail and collect and remit all applicable taxes.
       #     We sell communications services as a retailer with no place of business in NH.
       $     We are a reseller of communications services.  $PNNVOJDBUJPOT 4FSWJDFT 5BY "QQMJDBUJPO GPS 3FTBMF  'PSN %1      NVTU CF DPNQMFUFE XJUI UIJT BQQMJDBUJPO  

Under penalties of perjury, I declare that I have examined this application, 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 application with the preparer listed on this form.
TAXPAYER'S SIGNATURE & INFORMATION
Signature                                                                                                                               MMDDYYYY

Print Signatory Name & Title

Address

City / Town                                                   State Zip Code + 4 (or Canadian Postal Code)
                                                              
PREPARER'S SIGNATURE & INFORMATION 
Signature                                                                                                                               MMDDYYYY

Print Signatory Name & Title

Address

City / Town                                                   State Zip Code + 4 (or Canadian Postal Code)
                                                              
       DP-139                                                                                                                                                         Page 1 of 1
       7FSTJPO                                            ."*- 50   NH DRA,  PO BOX 637, CONCORD, NH 03302-0637