New Hampshire                    202           *SCHD032411862*
                     Department of
                                              Schedule III
                    Revenue Administration                                   SCHD032411862

                               NET FOREIGN DIVIDEND FACTOR INCREMENTS - SCHEDULE III

Principal Business Organization Name 

Taxpayer Identification Number                                      MMDDYYYY                 MMDDYYYY
                                     For the CALENDAR year 202  or           and ending:
                                     other taxable period beginning:

                     $0-6./ "                              $0-6./ #          $0-6./ $          $0-6./ %
                     NAME OF PAYOR                         DIVIDEND          TAXABLE INCOME    PERCENTAGE 
                                                                                              ($0-6./ B ÷ $0-6./ C)

1

2

3

4

5

6

7

8
                                             TOTAL 

 $0-6./ &                            $0-6./ '              $0-6./ (          $0-6./ )          $0-6./ *
 SALES AND RECEIPTS                  PAYROLL          BEGINNING PROPERTY     ENDING PROPERTY  AVERAGE PROPERTY 
                                                                                             ($0-6./ G + $0-6./ H) ÷ 2

1

2

3

4

5

6

7

8

 Schedule III 202                                                                                        Page 1 of 2
 Version      0 /202 

                     New Hampshire                          202                *SCHD032421862*
                     Department of
                                                        Schedule III
               Revenue Administration                                                 SCHD032421862

                     NET FOREIGN DIVIDEND FACTOR INCREMENTS - SCHEDULE III   DPOUJOVFE 

Principal Business Organization Name 

Taxpayer Identification Number                                              MMDDYYYY                        MMDDYYYY
                                      For the CALENDAR year 202  or                              and ending:
                                             other taxable period beginning:

  $0-6./ +                            $0-6./ ,               $0-6./ -                 $0-6./ .               $0-6./ /
          RENTS x 8                   TOTAL PROPERTY         MODIFIED SALES          MODIFIED PAYROLL       MODIFIED PROPERTY 
                                     ($0-6./ I  + $0-6./ J) ($0-6./ D x $0-6./ E)    ($0-6./ D x $0-6./ F)  ($0-6./ D x $0-6./ K)

1

2

3

4

5

6

7

8

                                                 TOTAL

  TOTALS   Carry total modified factor amounts to Form Schedule II, Lines 1(b), 4(b) and 5(b) 

  Schedule III 202                                                                                                  Page 2 of 2
  Version 1  0 /202