New Hampshire  
                            Department of      DP-144 *0DP1442411862*
                      Revenue Administration          0DP1442411862

                       COMMUNICATIONS SERVICES TAX REGISTRATION CHANGE REQUEST

CHANGE FROM: 
Company Name                                          CST Registration Number

Business Name                                         Taxpayer Identification Number

Number & Street Address

City / Town                                    State  Zip Code + 4 (or Canadian Postal Code)
                                                
CHANGE TO:
Company Name
                                                      If changing taxpayer identification 
                                                      number, new registration is needed.
Business Name

Number & Street Address

City / Town                                    State  Zip Code + 4 (or Canadian Postal Code)
                                                
R&26&45 50 '*-& 26"35&3-: 3&563/4 
 I request permission to file quarterly returns, and certify that: (1) my business is an operational, year-round business; (2) my business has 
 been in operation for a full year prior to this request; (3) my business is in full compliance with all provisions of RSA 82-A, including Rev 
 1600; and (4) the average Communication Services Tax liability of my business was less than $100 per month for the calendar quarter 
 immediately preceding this request.

NOTE:  You may not change your current filing requirements until your request is granted by the Department of Revenue Administration.

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-144                                                                                                                                 Page 1 of 1
 7FSTJPO                               ."*- 50   NH DRA,  PO BOX 637, CONCORD, NH 03302-0637