Form DP-300-Ext, “Payment Form and Application For Extension of Time to File Gambling Winnings Tax Return,” shall be completed and filed with the department by a taxpayer requesting an extension of time to file a return and shall contain the following information:

1. (a) The factors beyond the control of the taxpayer that prevent the filing of the return by the due date, including, but not limited to, unavailability of records; death, illness, or unavailability of the taxpayer; along with supporting documentation;
2. (b) The taxpayer's name, address, and taxpayer identification number as defined in Rev 2902.02;
3. (c) The date the taxpayer will be able to file the return, but in no event shall an extension be granted beyond four months following the due date of the return;
4. (d) 100% of the tax determined to be due;
5. (e) Amount of NH State tax as reported on federal Form W-2G or Form 1042-S; and,
6. (f) Balance of tax due.

Source. #9689-A, eff 4-2-10