New Hampshire Certification Request Form

Certification Request Form
Form AU-22
Reset Form

Print Form

New Hampshire
Department of
Revenue Administration

AU-22
CERTIFICATION REQUEST FORM

STEP 1

TYPE OR PRINT

BUSINESS NAME

TAXPAYER IDENTIFICATION NUMBER

NUMBER & STREET ADDRESS

DEPARTMENT IDENTIFICATION NUMBER (DIN)

ADDRESS (CONTINUED)

NH SECRETARY OF STATE IDENTIFICATION NUMBER

STATE

CITY / TOWN

ZIP CODE

IS CERTIFICATION LETTER TO BE SENT TO NAME & ADDRESS ABOVE?

Yes

COMMUNICATIONS SERVICE TAX REGISTRATION NUMBER

No

IF NO, ATTACH A POWER OF ATTORNEY (FORM DP-2848) AUTHORIZING US TO SEND TO
ADDRESS OTHER THAN BUSINESS ADDRESS ABOVE.

MEALS & RENTALS TAX LICENSE NUMBER

Entity Type

STEP 2 REQUEST TYPE
STATEMENT OF GOOD STANDING

CERTIFICATE OF DISSOLUTION

LLC FILING AS:

PROPRIETOR

CORPORATION

PARTNERSHIP

FIDUCIARY

STATEMENT FOR WITHDRAWAL

STEP 3 INFORMATION
1 Date registered with Secretary of State's Office to conduct business in New Hampshire

1

2 (a) Date of last business activity in New Hampshire

2a

(b) If this is a request for Withdrawal or Dissolution, has a final return encompassing the last day of
business been filed? If no, attach final return to request, or indicate date final return will be filed.

Yes

No

2b

3 Reason for request:

4 Which taxes have you filed with NH in the past? (Check all that apply and enter 4-digit year)
Interest and Dividends Tax

Real Estate Transfer Tax

Communications Services Tax

Business Taxes

Meals and Rentals Tax

Other

5 If filing as part of Combined Group indicate name and taxpayer identification number of company under which this entity files its NH returns:
TAXPAYER NAME

TAXPAYER IDENTIFICATION NUMBER

6 If requesting taxpayer is considered a disregarded entity for federal purposes (SMLLC), indicate name and taxpayer identification number of
company under which this entity reports its business activity federally:
TAXPAYER NAME

AU-22
REV. 1.11 09/2021

TAXPAYER IDENTIFICATION NUMBER

Page 1 of 4

New Hampshire
Department of
Revenue Administration

AU-22

CERTIFICATION REQUEST FORM Continued
STEP 4 ATTACHMENTS
1. Is the requesting company dissolving or liquidating? (If yes, see instructions)
2. For Good Standing requests, see instructions

Please note that the DRA has approximately 60
days to respond for a Dissolution or Withdrawal
and approximately 30 days for a Good Standing

3. A non-refundable fee of $30 made payable to the State of New Hampshire must be included
with this request. Requests submitted without the fee shall be denied.

Statement Request Fee

Yes

No

$

STEP 5 SIGNATURE AND TITLE

SIGNATURE (IN INK) OF THE CORPORATE OFFICER/PARTNER/MEMBER/PROPRIETOR

PRINT SIGNATORY NAME
COMPANY CONTACT NAME

DATE

TITLE
CONTACT TELEPHONE NUMBER

File online at Granite Tax Connect www.revenue.nh.gov/gtc or mail to NHDRA, PO Box 3306, Concord NH 03302-3306.

AU-22
REV. 1.11 09/2021

Page 2 of 4

New Hampshire
Department of
Revenue Administration

AU-22

CERTIFICATION REQUEST FORM

INSTRUCTIONS
WHO MUST FILE
Businesses are required to obtain a Certificate/Statement from the NH Department of Revenue Administration (NH DRA) prior to filing with the NH
Secretary of State Corporate Division. This requirement is mandated by law pursuant to RSA 293-A, the NH Business Corporation Act, and RSA 304-C,
Limited Liability Companies.
If not required to file taxes in NH, attach a copy of the first four pages of the federal return actually filed with the Internal Revenue Service (IRS) for
the period that includes the last date of business in NH.
WHAT TO FILE
Statement of Good Standing: Attach all returns that are due, but have not yet been filed with the NH DRA, including copies of all federal pages as filed
with IRS. See Rev 309.02 and Rev 2409.02.
Certificate of Dissolution: If not already filed with NH DRA, attach a final NH Business Enterprise and/or Business Profits Tax return with copies of all
federal pages, including forms 4797 and 6252, as filed with the IRS for the period that includes the last date of business in NH. Also, attach copies of: 1)
the minutes of the board of directors' meeting authorizing the dissolution; 2) a plan of liquidation; 3) a schedule detailing the distribution of all NH
assets; and if a corporation, 4) Federal Form 966. See Rev 309.03 and Rev 2409.03.
Statement for Withdrawal: If required to file taxes in NH and not already filed with NH DRA, attach a final NH Business Enterprise and/or Business
Profits Tax return with copies of all federal pages as filed with the IRS for the period that includes the last date of business in NH. Also attach a
statement addressing the disposition of all NH assets. If a plan of liquidation has been adopted, attach a copy of Federal Form 966. See Rev 309.04 and
2409.04.
WHEN TO FILE
A completed Form AU-22 and the $30.00 fee should be filed at least 60 days prior to application with the NH Secretary of State Corporate Division to
allow for a tax account reconciliation and processing. It is recommended that this request not be submitted before a final return is filed, as a
Certificate/Statement cannot be issued until a return encompassing the last business day in NH is filed.
WHERE TO FILE
File online at Granite Tax Connect www.revenue.nh.gov/gtc or mail to NH DRA, PO Box 3306, Concord, NH 03302-3306.
NEED HELP?
Call the Department of Revenue Administration, Taxpayer Services at (603) 230-5920. Individuals with hearing or speech impairments may call TDD
Access: Relay NH 1-800-735-2964.
NEED FORMS?
To obtain additional forms you may access our web site at www.revenue.nh.gov or call the forms line at (603) 230-5001.
LINE BY LINE INSTRUCTIONS
STEP 1: BUSINESS INFORMATION
Enter the business name, address, company contact name and telephone number. Check "Yes" or "No" as to whether the Certificate/Statement is to
be sent to address in Step 1. If no, then Form DP-2848, Power of Attorney, must accompany this form. Form DP-2848 is also required if company
contact is not an employee or officer.
Enter the Tax Identification Number (TIN) assigned to the business by the IRS. Enter the NH Department Identification Number (DIN) if one has been
assigned. Enter the NH Secretary of State Identification Number. Enter Communications Service Tax Registration Number, if applicable. Enter the
Meals & Rentals Tax Operator License Number, if applicable. Check the applicable entity type, and if the business is a limited liability company, check
the box.
STEP 2: REQUEST TYPE
Check the box indicating the type of Certificate/Statement you are requesting. If requesting more than one original Certificate/Statement, a separate
Form AU-22 and fee must be submitted for each additional request.
Dissolution vs. Withdrawal: If the requesting company is a domestic corporation or limited liability company, check the "Certificate of Corporation or
limited liability company, check the "Certificate of Dissolution" box. If the requesting company is a foreign corporation or limited liability company,
check the "Statement for Withdrawal" box.
AU-22 Instructions
REV. 1.11 09/2021

Page 3 of 4

New Hampshire
Department of
Revenue Administration

AU-22

CERTIFICATION REQUEST FORM

INSTRUCTIONS Continued
STEP 3: INFORMATION
Line 1
Enter the date the business registered with the Secretary of State's office to do business in New Hampshire.
Line 2(a) Enter the last or most recent day of business activity in New Hampshire.
Line 2(b) A final return encompassing the date of withdrawal or dissolution must be filed. Check the appropriate box to indicate if the final return has
been filed. If not, submit your completed final return with this request, or indicate the date of final return will be filed. If a final return has
not already been filed or does not accompany this form, your request will be delayed or denied until such time the final return is filed.
Line 3

Provide a complete explanation of the reason(s) for the request.

Line 4

Check the box(es) to indicate all New Hampshire taxes you have filed with the NH DRA. Enter the 4-digit year of the last return that was filed
with the NH DRA.

Line 5

Enter the name and TIN of the parent company, if applicable. If not, specify "No Parent" or specify principal NH filer if entity files as a
member of combined group.

Line 6

Enter the name and TIN of the federal reporting entity if taxpayer is a Single Member Limited Liability Company (SMLLC).

STEP 4: ATTACHMENTS
Line 1
Dissolution or liquidation requests require that you submit a copy of your Federal Form 966 and a copy of the minutes of the meeting held
when the decision to dissolve or liquidate was made. Check the appropriate box to indicate that you have included these documents, if
applicable.
Line 2

For Good Standing requests: If your business does not meet the minimum filing requirements for NH Business Profits or Business Enterprise
Taxes, include copies of pages 1 through 4 of your three most recent federal returns. See RSA 77-A:6 and RSA 77-E:5 for filing requirements.

Line 3

A non-refundable fee of $30 made payable to the State of New Hampshire must accompany the Form AU-22. Requests submitted without
the fee shall be denied.

Please note that the DRA has approximately 60 days to respond for a Dissolution or Withdrawal and approximately 30 days for a Good Standing.
STEP 5: SIGNATURE AND TITLE
Signature, in ink of a corporate officer, member, partner or proprietor, the title of that individual and the date of request was signed. If other than the
corporate officer, member, partner or proprietor, attach a completed Form DP-2848, Power of Attorney.
NOTE:
The Commissioner's determination is not the result of an audit and issuance of a Statement of Good Standing, Statement for Withdrawal,
or Certificate for Dissolution does not preclude audit of the business organization and its returns for any period within the statutory
provisions of RSA 21-J:29.

AU-22 Instructions
REV. 1.11 09/2021

Page 4 of 4