New Hampshire  
                     Department of                                          DP-143       *0DP1432411862*
            Revenue Administration                                                                                        0DP1432411862

                            COMMUNICATIONS SERVICES TAX APPLICATION FOR RESALE
Name of Applicant                                                                                                         CST Registration Number

Number & Street Address                                                                                                   Taxpayer Identification Number

Address (continued)

City / Town                                                                        State Zip Code + 4 (or Canadian Postal Code)
                                                                                    
Provide a detailed explanation of why you believe that your purchase of communications services are exempt from the Communications Services Tax pursuant to 
RSA 82-A:9. (Attach additional pages, if necessary.)

Provide a listing of businesses to whom you resell communications services.

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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 of Authorized Representative                                                                                    MMDDYYYY

Print Signatory Name & Title

DP-143                                                                                                                                           Page 1 of  
7FSTJPO                                ."*- 50   NH DRA, PO BOX 637, CONCORD, NH 03302-0637