DO NOT ATTACH TO RETURN

                    New Hampshire  
                        Department of             DP-9                                          *000DP92411862*
            Revenue Administration                                                                       000DP92411862

                        SMALL BUSINESS CORPORATION ("S" CORP) INFORMATION REPORT

Name of "S" Corporation                                                                            Federal Employer ID Number  Calendar Year

Number & Street Address                                                                            City / Town

Address (continued)                                                                                State      Zip Code + 4 (or Canadian Postal Code)
                                                                                                    
Total of all actual distributions made to New Hampshire residents for the period end.          $

Shareholder Name and Address (New Hampshire Residents ONLY)

Last Name                              First Name                                               MI       Social Security Number

Number & Street Address
                                                                                                         Amount of Distribution

City / Town                            State      Zip Code + 4 (or Canadian Postal Code)
                                        
Last Name                              First Name                                               MI       Social Security Number

Number & Street Address
                                                                                                         Amount of Distribution

City / Town                            State      Zip Code + 4 (or Canadian Postal Code)
                                        
Last Name                               First Name                                              MI       Social Security Number

Number & Street Address
                                                                                                         Amount of Distribution

City / Town                            State Zip Code + 4 (or Canadian Postal Code)
                                        
Last Name                              First Name                                               MI       Social Security Number

Number & Street Address
                                                                                                         Amount of Distribution

City / Town                            State Zip Code + 4 (or Canadian Postal Code)
                                        
DP 9 
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                  New Hampshire  
                       Department of                               DP-9    *000DP92421862*
              Revenue Administration                                                                     000DP92421862

Last Name                                               First Name                                  MI   Social Security Number

Number & Street Address
                                                                                                         Amount of Distribution

City / Town                                             State      Zip Code + 4 (or Canadian Postal Code)
                                                         
Last Name                                               First Name                                  MI   Social Security Number

Number & Street Address
                                                                                                         Amount of Distribution
City / Town                                             State Zip Code + 4 (or Canadian Postal Code)
                                                         
Last Name                                               First Name                                  MI   Social Security Number

Number & Street Address
                                                                                                         Amount of Distribution
City / Town                                             State      Zip Code + 4 (or Canadian Postal Code)
                                                                                                         If additional space is required, 
                                                                                                         attach another sheet.

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.
Signature (in ink) of Officer                                      Print Signatory Name & Title             MMDDYYYY

Signature (in ink) of Paid Preparer Other Than Taxpayer            MMDDYYYY
                                                                                                         DO NOT FILE WITH BUSINESS 
Print Preparer's Name                                              Preparer's Tax ID Number              RETURN. MAIL UNDER SEPARATE 
                                                                                                         COVER TO ADDRESS BELOW.
Number & Street Address
                                                                                                         FILE ONLINE AT GRANITE TAX CONNECT 
Address (continued)                                                                                      HUD SFWFOVF OI HPW 5"1 @ 
                                                                                                         Or Mail To:  NH DRA 
                                                                                                                  PO BOX 637 
City / Town                                             State Zip Code + 4 (or Canadian Postal Code)              CONCORD NH 03302-0637   
                                                         
DP 9                                                                                                                           1BHF   PG  
7FSTJPO     0 /202