New Hampshire Payment Form and Application for Extension of time

Payment Form and Application for Extension of time
DP-59-A
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New Hampshire

2023
DP-59-A

Department of
Revenue Administration

*0DP59A2311862*
0DP59A2311862

PAYMENT FORM AND APPLICATION FOR 7-MONTH
EXTENSION OF TIME TO FILE INTEREST AND DIVIDENDS TAX RETURN
MAKE YOUR PAYMENTS ONLINE AT
GRANITE TAX CONNECT
www.revenue.nh.gov/gtc

DO NOT FILE THIS FORM IF LINE 3 IS NEGATIVE OR ZERO
THIS IS NOT AN EXTENSION OF TIME TO PAY
For the CALENDAR year 2023 or other taxable period beginning:

ENTITY TYPE - Check One

MMDDYYYY

MMDDYYYY

1 - Individual/Joint

and ending:

3 - Partnership/LLC

4 - Estate

Last Name

First Name

MI

Social Security Number

Taxpayer Identification Number

Spouse's Last Name

First Name

MI

If issued a DIN, use DIN in the
appropriate taxpayer
identification box.
DO NOT enter SSN or FEIN

Social Security Number

Name of Partnership, Estate, or LLC

Number & Street Address

Address (continued)

State

City / Town

Zip Code + 4 (or Canadian Postal Code)

100% PAYMENT IS DUE ON OR BEFORE THE DUE DATE OF THE TAX
File online at Granite Tax Connect
www.revenue.nh.gov/gtc
Make check payable to:
State of New Hampshire
Mail to: NH DRA
PO BOX 1265
CONCORD NH 03302-1265
Enclose, but do not staple or tape your
payment to this extension.
If negative or zero DO NOT file this
application.

DP-59-A 2023
Version 1 07/2023

1

Round to the nearest whole dollar

Enter 100% of the Interest and Dividends Tax determined to be due (net of
RSA 77-G Education Tax Credit)

2(a) Enter credit carried over from prior
year and total estimated tax payments
2(b) Enter payment previously made,
if applicable
2

Total advance payments and credits
(Line 2(a) plus Line 2(b))

3

NET BALANCE DUE:
(Line 1 minus Line 2)

Pay This Amount

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New Hampshire
Department of
Revenue Administration

2023
DP-59-A

PAYMENT FORM AND APPLICATION FOR 7-MONTH
EXTENSION OF TIME TO FILE INTEREST AND DIVIDENDS TAX RETURN
DO NOT FILE THIS FORM IF LINE 3 IS NEGATIVE OR ZERO
THIS IS NOT AN EXTENSION OF TIME TO PAY

MAKE YOUR PAYMENTS ONLINE AT
GRANITE TAX CONNECT
www.revenue.nh.gov/gtc

WHO MUST FILE
Taxpayers who have not paid 100% of the Interest and Dividends Tax determined to be due by the due date of the tax and are requesting a 7-month
extension to file their Interest and Dividends Tax return. To make an additional payment in order to have paid 100% of the tax determined to be due,
you may submit this form with payment or make your payment electronically by accessing Granite Tax Connect at www.revenue.nh.gov/gtc by the
original due date of the tax. An extension will not be granted if 100% of the tax determined to be due is not paid timely.
Do not file this form if Net Balance Due (Line 3) is zero.
Enter the beginning and ending dates of the taxable period.
TAXPAYER IDENTIFICATION
The Commissioner of the Department of Revenue is authorized pursuant to RSA 21-J:27-a to require submission of an SSN, FEIN, or any other
identifying number used in filing or preparing federal tax documents. If you do not have any such identifying number, or share one with another
taxpayer, then, under N.H. Code of Admin. Rules, Rev 2903.01, you must obtain a Department Identification Number (DIN). If you have a DIN, use it
on all New Hampshire filings. To ensure that your filings and payments are applied to the correct account, the sequence of names and taxpayer ID
numbers on all filings must be consistent. The failure to provide a taxpayer identification number may result in the rejection of filed documents.
Failure to timely file documents complete with a consistent taxpayer identification number may result in the imposition of penalties and interest, the
disallowance of claimed exemptions, exclusions, credits, deductions, or an adjustment that may result in increased tax liability.
Enter the taxpayer's name and taxpayer identification number in the spaces provided.
AUTOMATIC EXTENSION
If you have paid 100% of your Interest & Dividends Tax determined to be due by the due date of the tax, you will be granted an automatic 7-month
extension to file your New Hampshire Interest and Dividends Tax return WITHOUT filing this form. If you meet this requirement, you may file your
New Hampshire Interest and Dividends Tax return up to 7 months beyond the original due date of the return and you will not be subject to the late
filing penalty. Note that an extension of time to file your return is not an extension of time to pay the tax.
WHEN TO FILE
This form must be postmarked on or before the original due date of the return. Electronic payments must be received before midnight on the due
date of the tax.
WHERE TO FILE
File online at Granite Tax Connect www.revenue.nh.gov/gtc or mail to NH DRA, PO Box 1265, Concord, NH 03302-1265.
E-FILE
If you pay online, you do not need to file this form. Electronic payments must be received before midnight on the due date of the tax.
REASONS FOR DENIAL
Applications for extensions will be denied for reasons such as, but not limited to, the application was postmarked after the due date for filing the
return, or the payment of the balance due shown on Line 3 did not accompany the application or was not received electronically before midnight on
the due date of the tax.
NEED HELP?
Questions not covered here may be answered in our “Frequently Asked Questions” available on our website at: www.revenue.nh.gov or call Taxpayer
Services at (603) 230-5920, Monday through Friday, 8:00 am to 4:30 pm. All written correspondence to the Department should include the taxpayer
name, taxpayer identification number, the name of a contact person and a daytime telephone number. Individuals who need auxiliary aids for
effective communications in programs and services of the New Hampshire Department of Revenue Administration are invited to make their needs
and preferences known. Individuals with hearing or speech impairments may call TDD Access: Relay NH 1-800-735-2964.

DP-59-A 2023
Version 1 07/2023

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