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NEW HAMPSHIRE DEPARTMENT OF REVENUE ADMINISTRATION
   FORM
                                                         PACKAGE X ORDER FORM
 DP-76
    201
                                                                                                            FOR DRA USE ONLY




ATTENTION: This form has been revised so that it may be used for this year and future tax years. The Department will no
longer be mailing this order form annually.

Use this form to order a New Hampshire Package X. All forms included in the Package X may be reproduced. Individual
forms may be downloaded from the Department's web site at www.nh.gov/revenue or by calling (603) 271-2192.



                       NH DRA
      MAIL TO:
                       PO BOX 637
                       CONCORD, NH 03302-0637

     Make checks payable to: STATE OF NEW HAMPSHIRE


   TYPE or PRINT clearly and accurately to assure prompt response:



    Business Name:


              ATTN:

    Mailing Address:


     Street Address:


          City/Town:


                                                                                                                      Ext:
                                                                                  Zip Code:
              State:


    Foreign Country:



                                                                                                                             TOTAL
                                                                                                        Multiply by
                                                                                              Number
                                                                                                                             PRICE
                                                                                                        Price each
                                                                                              Ordered
                       Package quot;Xquot;
                                                                                              #          @ $6.00        $
                       Hardcopy for the current tax period.
                       You may obtain Package quot;Xquot; for free from our web site at                   TOTAL AMOUNT
                       www.nh.gov/revenue                                                                               $
                                                                                                  ENCLOSED
 FOR DRA USE ONLY




                                                                                                                                  DP-76
                                                                                                                               Rev. 12/2008

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Package X Order Form

  • 1. NEW HAMPSHIRE DEPARTMENT OF REVENUE ADMINISTRATION FORM PACKAGE X ORDER FORM DP-76 201 FOR DRA USE ONLY ATTENTION: This form has been revised so that it may be used for this year and future tax years. The Department will no longer be mailing this order form annually. Use this form to order a New Hampshire Package X. All forms included in the Package X may be reproduced. Individual forms may be downloaded from the Department's web site at www.nh.gov/revenue or by calling (603) 271-2192. NH DRA MAIL TO: PO BOX 637 CONCORD, NH 03302-0637 Make checks payable to: STATE OF NEW HAMPSHIRE TYPE or PRINT clearly and accurately to assure prompt response: Business Name: ATTN: Mailing Address: Street Address: City/Town: Ext: Zip Code: State: Foreign Country: TOTAL Multiply by Number PRICE Price each Ordered Package quot;Xquot; # @ $6.00 $ Hardcopy for the current tax period. You may obtain Package quot;Xquot; for free from our web site at TOTAL AMOUNT www.nh.gov/revenue $ ENCLOSED FOR DRA USE ONLY DP-76 Rev. 12/2008