New Hampshire Report of Address Change

Report of Address Change
dp-100-2016 (1).pdf
New Hampshire
Department of
Revenue Administration

Print Form

Form DP-100
Report of
Address Change

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WHEN TO FILE
File this form to notify the New Hampshire Department of Revenue Administration of an address change.
Note: Not for use for Meals and Rentals or Communications Service Tax. Meals & Rentals Operators use form CD-100. Communications
Services Tax use Form DP-144.
INSTRUCTIONS
1 Select the tax type for which the address change applies.
2 Enter the Taxpayer Identification Number (Social Security Number (SSN), Federal Employer Identification Number (FEIN), or Department
Identification Number (DIN)).
3 Enter the Taxpayer's name and mailing address.
4 Enter the Taxpayer's new mailing address
5 Signature, in ink, of the taxpayer, or if authorized, a corporate officer, member, or partner; the name and title of that individual; and the
date the report was signed.
WHERE TO FILE
Mail to:
NH DRA
PO BOX 637
CONCORD, NH 03302-0637
NEED HELP?
Call Taxpayer Services at (603) 230-5920, Monday through Friday, 8:00am - 4:30pm. Individuals with hearing or speech impairments may
call TDD Access: Relay NH 1-800-735-2964.
DO NOT CUT

2 Taxpayer Identification #

1 Tax Type

FEIN

DIN

SSN

3 Taxpayer Name and Mailing Address

MI

First Name

Last Name
Business Name
Number & Street Address
Address (continued)
City / Town

4

State

Zip Code

State

Zip Code

New Mailing Address

Number & Street Address
Address (continued)
City / Town

FOR DRA USE ONLY

If signed by a corporate officer or fiduciary on behalf of the taxpayer, I certify that I have the authority to sign
this address change on behalf of the taxpayer.
5 SIGNATURE (IN INK)
PRINT NAME & TITLE
DP-100
Version 1 6/2017

Date

Date
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