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NEWHAMPSHIREDEPARTMENTOFREVENUEADMINISTRATIONQUALIFIEDINVESTMENTCOMPANY(QIC)REPORTFEDERALEMPLOYERIDENTIFICATIONNUMBERORDEPARTMENTIDENTIFICATIONNUMBERNAMEOFBUSINESSORGANIZATIONNUMBER&STREETADDRESSCITY/TOWN,STATE&ZIPCODETaxablePeriodBeginningandEndingMoDayYearMoDayYearFORMAU-208SIGNATURE(ININK)OFDULYAUTHORIZEDREPRESENTATIVESIGNATURE(ININK)OFPAIDPREPAREROTHERTHANAUTHORIZEDREPRESENTATIVEPREPARER'SIDENTIFICATIONNUMBERDATEPREPARER'SADDRESSCITY/TOWN,STATE&ZIPCODETHISFORMMUSTBEMAILEDUNDERSEPARATECOVERTO:NHDEPTOFREVENUEADMINISTRATIONAUDITDIVISIONPOBOX457CONCORDNH03302-0457AU-208Rev02/2011ADDRESS(continued)AggregateAmountofFundsInvestedasofPeriodEndQICINTERESTHOLDERS:PROPORTIONALNAMEADDRESSFEINORSSNSHAREOFINCOMEQICMANAGERNAMENUMBERANDSTREETADDRESSIncomeReceivedintheTaxablePeriodExpensesIncurredintheTaxablePeriod.
STEP1STEP2STEP3STEP4STEP5CITY/TOWN,STATE&ZIPCODEADDRESS(continued)FEDERALEMPLOYERIDENTIFICATIONNUMBERSTEP6CheckthisboxifacopyofFederalTaxReturnisattachedinlieuofcompletingSteps2through4above.
SUBMITTHISFORMUNDERSEPARATECOVER,DONOTATTACHTONEWHAMPSHIREBUSINESSTAXRETURN(ATTACHSUPPORTINGSCHEDULE)(ATTACHSUPPORTINGSCHEDULE)PRINTSIGNATORYNAME&TITLEDATENEWHAMPSHIREDEPARTMENTOFREVENUEADMINISTRATIONQUALIFIEDINVESTMENTCOMPANY(QIC)REPORTFORMAU-208InstructionsGENERALINSTRUCTIONSAU-208InstructionsRev02/2011WHOMUSTFILEAbusinessorganizationthatelectsqualiedinvestmentcompany(QIC)statusforthestatedtaxableperiod(andallsucceedingtaxableperiodsuntiltheelectionisterminated)isrequiredtoannuallylethisreportwiththeDepartment.
WHATTOFILEThisreportcompletedthroughStep6,OR,thereportwithStep1,Step5andStep6completedaccompaniedbyacopyoftheQICfederalincometaxreturnledwiththeInternalRevenueServiceforthetaxableperiod,shallbeledwiththeDepartment.
WHENTOFILEThereport,alongwithacopyoftheQICfederalincometaxreturn,ifsuchlingmethodischosen,mustbeledwiththeDepartmentonorbefore30daysfollowingthelingoftheQICsfederalincometaxreturnwiththeInternalRevenueServiceforthetaxableperiod.
WHERETOFILEThereportandaccompanyingdocuments,ifapplicable,shallbemailedtotheNHDepartmentofRevenueAdministration,AuditDivision,109PleasantStreet,POBox457,Concord,NH03302-0457.
PENALTYFORFAILURETOTIMELYFILEREPORTAnyQICwhichfailstotimelylethereportasrequiredbyRSA77-A:5-b,IIshallpayapenaltyequalto$100foreachdaysuchreportisnotled,unlessanextensionhasbeengrantedbytheCommissioner.
Innoeventshallthemonetaryneimposedexceed$5,000.
AQICnotiedbytheDepartmentthatsuchreportisoverduebymorethan50daysshallhave30daysfromthedateofsuchnoticationtolethedelinquentreport.
Ifthedelinquentreportisnotledwithin30daysafternotication,theCommissionershalldisallowthebusinessorganization'sQICstatusforanytaxableperiodforwhichatimelyreporthasnotbeenled.
RECORDKEEPINGAllofthenormaltaxadministrationpowersgiventotheDepartmentwithrespecttoothertaxesandtaxpayersarealsoapplicabletoQICs.
InaccordancewiththeprovisionsofRSA77-A:5-b,IV,QICsaresubjecttotherequirementsofRSA77-A:11andRSA77-E:10.
SuchorganizationsmustcomplywiththestandardrecordkeepingandavailabilityofrecordsforauditrequirementsthatapplytootherNHbusinesstaxpayers.
NEEDHELPFormoreinformationconcerningthisreportyoumaycalltheAuditDivisionat(603)271-3400.
NEEDFORMSToobtaintheformneededtolethisreportvisitourwebsiteatwww.
nh.
gov/revenue,orcalltheformslineat(603)271-2192.
STEPBYSTEPINSTRUCTIONSSTEP1Enterthename,addressandFederalEmployerIdenticationNumberorDepartmentIdenticationNumberofthebusinessorganizationsubmittingthisreportinthespacesprovided.
STEP2EntertheaggregateamountoffundsinvestedintheQICasoftheperiodend;thenames,addresses,FederalEmployerIdenticationNumbersorSocialSecurityNumbersofholdersofthecompanyandtheirproportionalshareofincome.
STEP3Enterthename,addressandFederalEmployerIdenticationNumberofthemanageroftheQIC,ifany.
STEP4EntertheamountofincomereceivedandexpensesincurredbytheQICinthetaxableperiod.
Attachsupportingschedulesasnecessary.
STEP5ChecktheboxinStep5onlyifacopyofthefederalreturnisbeingsubmittedwiththisreport.
STEP6Signatureofthedulyauthorizedrepresentative(inink).
Indicatethetitleoftherepresentativeandthedate.
Ifthereportispreparedbysomeoneotherthanthedulyauthorizedrepresentativepleasesign,inink,andgiveFederalEmployerIdenticationNumber,addressandthedate.
-OR-STEP1Enterthename,addressandFederalEmployerIdenticationNumberorDepartmentIdenticationNumberofthebusinessorganizationsubmittingthisreportinthespacesprovided.
STEP2-4AttachacopyoffederalincometaxreturnasledwiththeInternalRevenueServiceforthetaxableperiod.
STEP5Indicatebycheckingtheboxthatthefederalreturnisbeingsubmittedwiththisreport.
STEP6Signatureofthedulyauthorizedrepresentative(inink).
Indicatethetitleoftherepresentativeandthedate.
Ifthereportispreparedbysomeoneotherthanthedulyauthorizedrepresentativepleasesign,inink,andgiveFederalEmployerIdenticationNumber,addressandthedate.