N.H. Code Admin. R. Saf-C 1011.04
(c) Applicants submitting form DSMV 637 shall sign and date the form, and in doing so, shall certify the following under the penalties of unsworn falsification pursuant to RSA 641:3:
“By signing above, I certify that I have paid all resident taxes or Interest and Dividends Tax (RSA 77) for which I am liable, and, if required, insurance certificates are on file with the Director of Motor Vehicles. My driving privileges are not subject to or under disqualification, suspension or revocation by any jurisdiction (does not apply to non-driver ID). This application is signed under penalty of unsworn falsification pursuant to RSA 641:3.”
Source. #8109, eff 6-24-04; ss by #10176, eff 8-23-12 (from Saf-C 1010.05); ss by #12614, eff 8-23-18; ss by #13685, eff 8-5-23 (formerly Saf-C 1011.05) (see Revision Note at chapter heading for Saf-C 1000)