New Hampshire  
                                                                                                    Department of                                DP-14                             *00DP142311862*
                                                                                              Revenue Administration                                                                     00DP142311862
                                                                                                                                      MEALS & RENTALS TAX RETURN                                                          Amended Return
Business Name                                                                                                                                                              IF THIS IS YOUR FINAL RETURN, FILE FORM CD-100 AND GIVE REASON:
                                                                                                                                                                                       1 - Business Discontinued  Last Day of Business
License Number                                                                                                                                   Tax Period (MMYYYY)                   2 - Change in Organization MMDDYYYY
                                                                                                         Due on the 15th day of the month 
                                                                                                         following the close of the tax period.                                        3 - Business Sold

                                                                               1. Tax excluded receipts                                                                              1                                   Round to the nearest  
                                                                                                                                                                                                                         whole dollar
                                                                               2. Meals Tax at 8.5% (Multiply Line 1 by .085)                                                       2

                                                                               3. Tax included receipts                                                                             3

                                                                 and Beverages 4. Meals Tax at 7.834% (Multiply Line 3 by .07834)                                                   4

                    Receipts From Meals                                        5. Total Meals Tax (Line 2 plus Line 4)                                                            

                                                                               6. Room rental receipts                                                                              6

                                                                               7. Permanent resident receipts                                                                      7

                                                                               8. Taxable room rental receipts (Line 6 minus Line 7)                                               8
                                                                               9. Total room rental tax
                                                                                        (multiply Line 8 by .085 or .07834)     Check rate used: .085                .07834         

                                                                               10. Motor vehicle rental receipts                                                                 10
                                        Receipts From Rentals                  11. Total motor vehicle rental tax
                                                                                          (multiply Line 10 by .085 or .07834)  Check rate used: .085               .07834        
                                                                                                                                                                                      
                                                                               12. Total tax (Line 5 plus Line 9 plus Line 11)                                               
                                                                               13. Commission (Line 12 multiplied by .03) (See 3% commission eligibility 
                                                                                     requirements in General Instructions)                                                       13

                                                                               14. Original return payment/credits/estimated payments                                            14
                                                                                                                                                                                      
                                                                                     Total deductions (Line 13 plus Line 14)                                                 

                                                                               16. Interest (see instructions)                                                                         16

                                                                               17. Penalty for failure to pay (see instructions)                                                       17

                                                                               18. Penalty for failure to file (see instructions)                                                      18

                                        Deductions and Additions                     Total additions (sum of Lines 16, 17, & 18)                                              
                                                                               20. Total Due (Line 12 minus Line 15, plus Line 19)
                                                                                              Make checks payable to State of New Hampshire                                        

                                                                               21. Tax exempt meals and rental receipts                                                          2 
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 operator, this declaration is based on all information of which the preparer has knowledge.)
Signature (in ink) (Failure to sign may result in assessment of penalties)                                                                        MMDDYYYY                               Phone Number

Signature (in ink) Preparer Other Than Operator                                                                                                  MMDDYYYY                              Preparer Address, City, State, Zip

Print Preparer's Name                                                                                                                            Preparer's Tax ID Number

                                                                               DP-14                        MAIL TO:  NH DRA, TAXPAYER SERVICES, PO BOX 637, CONCORD, NH 03302-0637 
                                                                               Version        /202 
                                                                                                                       Enclose, but do not staple or tape your payment with the return