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New Hampshire Settlement Agreement Offer
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Extracted from PDF file 2024-new-hampshire-cd-410.pdf, last modified May 2024Settlement Agreement Offer
New Hampshire Department of Revenue Administration Entity Type of Taxpayer Individual(s) Form CD-410 Settlement Agreement Offer Proprietorship Print Form Partnership LLC Taxpayer Name Reset Form Corporation Taxpayer ID / License No. Mailing Address State City Zip Code New Address? Daytime Telephone Number Yes No This offer is submitted to settle a liability resulting from failure to pay a New Hampshire tax administered by the Department of Revenue Administration as follows (Please enclose a copy of any Notices of Assessment): Owed Offer Interest and Dividends Tax $ $ Business Tax (Business Profits / Business Enterprise Tax) $ $ Meals and Rentals Tax $ $ Other (Specify) $ $ Gross income during past 12 months $ Gross wages paid during past 12 months $ Monthly Expenses: Rent $ Mortgage $ Utilities $ Vehicles $ Insurance $ Advertising $ Other (Specify) $ Assets: Cash on Hand (Enclose two most recent monthly bank statements for each account): Bank 1: $ Bank 2: $ Bank 3: $ Money Market Accounts $ Receivables (Description) $ Inventory (Description) $ Continued on Page 2 Form CD-410 Version 1 6/2014 Page 1 of 2 New Hampshire Department of Revenue Administration Form CD-410 Settlement Agreement Offer Assets (continued): Investments (Description) $ Business Equipment (Description) $ Real Estate 1 Address Market Value $ Real Estate 2 Address Market Value $ Real Estate 3 Address Market Value $ Liabilities: Taxes due (Other State Agencies, IRS, Real Estate Taxes, etc.) $ Credit Card Debt/Accounts Payable $ Loans owed to banks $ Real Estate Mortgages $ Available Credit Credit Line $ Balance $ In addition to Bank Statements: Business Taxpayers: Please enclose your most recent Financial Statements Individuals: Please enclose a copy of your most recent Federal 1040 tax return as filed with the Internal Revenue Service Please describe the circumstances which resulted in the inability to pay the taxes due in full: Under penalties of perjury, I declare that I have examined this offer, including accompanying schedules and statements, and to the best of my knowledge and belief the information is true, correct and complete. Signature Date Print Name Form CD-410 Version 1 8/2014 Title Please complete the requested information and mail to: NHDRA Collections Division PO BOX 454 CONCORD, NH 03302-0454 Page 2 of 2
cd-410-2016_PRO1.pdf
More about the New Hampshire CD-410 Other TY 2024
We last updated the Settlement Agreement Offer in March 2025, so this is the latest version of CD-410, fully updated for tax year 2024. You can download or print current or past-year PDFs of CD-410 directly from TaxFormFinder. You can print other New Hampshire tax forms here.
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TaxFormFinder has an additional 51 New Hampshire income tax forms that you may need, plus all federal income tax forms.
| Form Code | Form Name |
|---|---|
| Form NH-PYT | General Tax Payment Voucher |
| Form A-101 | Tax Appeal Form |
| CD-410 | Settlement Agreement Offer |
| CD-57-P | Real Estate Transfer Tax Declaration of Consideration (Purchaser) |
| CD-57-S | Real Estate Transfer Tax Declaration of Consideration (Seller) |
View all 52 New Hampshire Income Tax Forms
Form Sources:
New Hampshire usually releases forms for the current tax year between January and April. We last updated New Hampshire CD-410 from the Department of Revenue Administration in March 2025.
Historical Past-Year Versions of New Hampshire CD-410
We have a total of six past-year versions of CD-410 in the TaxFormFinder archives, including for the previous tax year. Download past year versions of this tax form as PDFs here:
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