Form Dp-143 - Communications Services Tax - Application For Resale

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NEW HAMPSHIRE DEPARTMENT OF REVENUE ADMINISTRATION
FORM
DP-143
COMMUNICATIONS SERVICES TAX
APPLICATION FOR RESALE
NAME OF COMPANY/RESELLER
RESALE CERTIFICATE NUMBER (DRA use only)
NUMBER & STREET ADDRESS
COMMUNICATIONS TAX REGISTRATION NUMBER
ADDRESS (CONTINUED)
FEDERAL EMPLOYER IDENTIFICATION NUMBER
CITY/TOWN, STATE & ZIP CODE+4
SOCIAL SECURITY NUMBER
Provide a detailed explanation why you believe that your purchases of communications services are exempt from the communications services tax pursuant
to RSA 82-A:9. (Attach additional pages, if necessary.) If applicable, this is required information.
Provide a statement which indicates the percentage of purchases that are resold AND whether you purchased communications services are used for any
of your own administrative purposes. (Attach additional pages, if necessary.) If applicable, this is required information.
Provide an explanation of how you calculated the resale percentage. If applicable, this is required information.
Under penalties of perjury, I declare that I have examined this document and to the best of my belief it is true, correct and complete.
DATE
SIGNATURE (IN INK) OF AUTHORIZED REPRESENTATIVE
PRINT SIGNATORY NAME & TITLE
NH DRA
MAIL
AUDIT DIVISION
TO:
PO BOX 457
CONCORD NH 03302-0457
DP-143
Rev 02/2011

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