State of NH Revenue Dept
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Report Tax Fraud



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Step 1: Information About the Taxpayer You Are Reporting

 
 
1.   Taxpayer Name    (Type Answer)
 
(100 character limit; 100 remaining.)
 
2.   Taxpayer Identification Number    (Type Answer)
 
(100 character limit; 100 remaining.)
 
3.   Business Name or DBA    (Type Answer)
 
(100 character limit; 100 remaining.)
 
4.   Business Owner’s Name(s)    (Type Answer)
 
(100 character limit; 100 remaining.)
 
5.   Address
 
Address Line 1:
Address Line 2:
City / State / Zip:

6.   Principal Activity of the Business    (Type Answer)
 
(100 character limit; 100 remaining.)
 
7.   Phone Number - Step 1 (Example: 999-111-0000)
  Ext:
 

Step 2: Information About the Alleged Violation

 
 
8.   Type of Tax Related to the Fraud    (Select one)
  Business Taxes    Interest & Dividends Tax    Meals & Rentals Tax    Real Estate Transfer Tax    Tobacco Tax    Other Tax     
 
9.   Banks and Financial Institutions Used (if known)    (Type Answer)
 
(100 character limit; 100 remaining.)
 
10.   Brief description of the fraud being reported    (Type Answer)
 
(500 character limit; 500 remaining.)
 
11.   Explain where and when the fraud happened and include any additional information    (Type Answer)
 
(500 character limit; 500 remaining.)
 

Step 3: Information About Yourself (Optional)

 
 
12.   Name    (Type Answer)
 
(100 character limit; 100 remaining.)
 
13.   Email Address    (Type Answer)
 
(100 character limit; 100 remaining.)
 
14.   Address
 
Address Line 1:
Address Line 2:
City / State / Zip:

15.   Phone Number - Step 3 (Example: 999-111-0000)
  Ext:
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