Havenstein BLC Petition 6/2014

STATE OF NEW HAMPSHIRE
BALLOT LAW COMMISSION

Petition of Walter P. Havenstein
BLC
VERIFIED PETITION
Pursuant to RSA 665:7, the petitioner, Walter P. Havenstein, respectfully requests a
ruling from the Ballot Law Commission ("BLC") that he meets the seven-year inhabitant
requirement set forth in Part II, Article 42 of the New Hampshire Constitution and RSA 655:5 to
be eligible to run for and hold the office of Governor of the State of New Hampshire. In support
thereof, Mr. Havenstein states as follows.
INTRODUCTION
1. On June 11, 2014, Mr. Havenstein tiled as a candidate for the office of Governor
of the State of New Hampshire with the New Hampshire Secretary of State's Office.
2. A dispute exists between Mr. Havenstein and certain individuals and entities that
have publicly and erroneously suggested that Mr. Havenstein does not meet the seven-year
inhabitant requirement to hold the office of Governor of the State of New Hampshire. These
individuals and entities include the New Hampshire Democratic Party and current National
Democratic Committeewoman Kathleen N. Sullivan.
3. These meritless and irresponsible allegations are intended to negatively impact
Mr. Havenstein and his campaign and are designed primarily to mislead members of the public
about Mr. Havenstein and his candidacy for governor.
4. Mr. Havenstein therefore requests a ruling from the BLC that he meets the seven-
year residency requirement to hold the office of Governor of the State of New Hampshire.
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Such a ruling will benefit Mr. Havenstein, his campaign, his supporters and
contributors, and members of the public at large by confirming that Mr. Havenstein is and will be
a valid candidate for the office of Governor throughout the 2014 election cycle and beyond.
JURISDICTION
6. The BLC has jurisdiction to issue a ruling pursuant to RSA 665:7 because Mr.
Havenstein filed as a candidate for the office of Governor of the State of New Hampshire on
June 11, 2014 with the New Hampshire Secretary of State's Office and a dispute exists over
whether his declaration of candidacy conforms with the law.
PARTIES
7. Walter P. Havenstein, 112 Dewitt Drive, Alton, New Hampshire, 03809,
candidate for Governor of the State of New Hampshire.
POTENTIALLY INTERESTED PARTIES
8. The New Hampshire Democratic Party, 105 N. State Street, Concord, NH 03301.
9. Kathleen N. Sullivan, Esq., Wadleigh, Starr & Peters, PLLC, 95 Market Street,
Manchester, NH 03101.
10. Governor Margaret Hassan, Office of the Governor, State House, 107 North Main
Street. Concord, NH 03301.
11. Hemingway for Governor, 1850 Elm St. Manchester, NH 03104.
FACTS
12. Mr. Havenstein and his wife, Judy, purchased a home in and moved to Bedford,
New Hampshire in 1999 when Mr. Havenstein became executive vice president of Sanders, a
Lockheed Martin Company, in Nashua, New Hampshire. Mr. and Mrs. Havenstein have one
son, who lived with his family in New Hampshire from 2001 to 2013 until he and his family
moved to Texas.
13. In 2000, BAE Systems North America acquired Sanders, a Lockheed Martin
Company. Mr. Havenstein continued working for BAE Systems North America and served as
president of BAE Systems Integrated Electronic Warfare Systems (`BAE Systems IEWS-). Mr.
Havenstein continued to perform the functions of these positions from Nashua, New Hampshire.
14. While Mr. Havenstein lived in Bedford, New Hampshire, he paid property taxes
there. He tiled his federal income taxes from Bedford, New Hampshire. He had his car
registered in New Hampshire and maintained a New Hampshire driver's license. He was also
registered to vote, and did vote, in Bedford, New Hampshire, and nowhere else.
15. While Mr. Havenstein lived in Bedford, New Hampshire, his wife, Judy, served
as: the Town Chair ofJohn S. McCain III's 2000 Campaign for President of the United States; a
delegate to the Hillsborough County Republican Committee; a New Hampshire delegate to the
National GOP Convention in New York City in 2000; and Vice-Chair of the Bedford Republican
Committee.
16. In 2003, Mr. Havenstein and his wife purchased property in Alton, New
Hampshire and had a home built on it. In May 2004, after construction was complete, Mr.
Havenstein and his wife moved into their new home in Alton, New Hampshire. where they
planned to live for the rest of their lives.
17. Mr. Havenstein subsequently registered to vote in Alton. New Hampshire, and has
remained registered to vote in Alton, New Hampshire and nowhere else to the present day.
18. From 2004 to 2005, Mr. Havenstein was promoted to executive vice president of
BAE Systems North America. Mr. Havenstein performed the functions of this position from
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Rockville, Maryland and commuted from his home in New Hampshire to Rockville, Maryland
by airplane during this time.
19. In 2005, Mr. Havenstein was offered the opportunity to become president of BAE
Systems Information and Electronic Systems Integration ("BAE Systems IESI") in Nashua, New
Hampshire. Mr. Havenstein accepted this position and served in it until January 2007. While
working at BAE Systems IESI, Mr. Havenstein commuted from his home in Alton, New
Hampshire to Nashua, New Hampshire.
20. In January 2007, Mr. Havenstein was offered the opportunity to become
Chairman and CEO of BAE Systems, Inc.. a parent company of BAE Systems IESI.
21. These positions required Mr. Havenstein to spend a significant portion of the year
working outside of New Hampshire. Specifically, BAE Systems, Inc. is headquartered in
Maryland and is owned by BAE Systems PLC in London, England. In order to accommodate
this work arrangement, Mr. Havenstein purchased a condominium in Bethesda, Maryland, and
commuted home to Alton, New Hampshire on weekends, holidays, and whenever else possible.
22. In connection with the purchase of that property, Mr. Havenstein qualified for a
recordation tax exemption under Maryland law, which indicates that if the owner actually
occupies the residence for at least seven of the next twelve months immediately after the
property is conveyed, the property is considered a principal residence. See Md. Tax-Property
Code Ann. 12-103(b)(2) (2014); Aff. of Purchase Regarding Exemption From Recordation Tax
(Montgomery County) c2, a true and correct copy of which is attached hereto as Exhibit A.
23. In applying for this tax exemption, Mr. Havenstein did not change his domicile
from New Hampshire to Maryland. Rather, Mr. Havenstein always considered New Hampshire
to be his domicile since he moved to the state in 1999. His residence in Maryland was temporary
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while he completed his duties at BAE Systems, Inc., toward the end of a long and successful
business career, after which he intended to reside full-time at his domicile in Alton, New
Hampshire.
24. Because Mr. Havenstein was temporarily residing in Maryland for work, he
purchased an automobile in Maryland so he could travel to his job. Maryland law required Mr.
Havenstein to register this vehicle in Maryland and to obtain a Maryland driver's license. See
Exhibit B, Maryland, Department of Transportation, Motor Vehicle Registration, New To
Maryland Titling And Registering Your Vehicle Information (`Às a new resident of Maryland
you must register your vehicle within 60 days of moving to Maryland. If you delay beyond 60
days. .. . you may be subject to a citation for an out of state registration"); id., New To Maryland
Driver's Licensing Information ("If you are a new resident of Maryland and you hold a
noncommercial driver's license, you have 60 days to obtain a Maryland Driver's License").'
25. Mr. Havenstein and his wife continued to register vehicles used at their Alton,
New Hampshire home with the New Hampshire Division of Motor Vehicles. See May 23, 2014
Letter from New Hampshire Department of Safety, Division of Motor Vehicles, Bureau of
Registration. Research Desk, a true and correct copy of which is attached hereto as Exhibit C.
26. In 2008, Mr. Havenstein was issued a Maryland homestead property tax
exemption on his condominium as his principal residence under Maryland law. By applying for
this tax exemption, Mr. Havenstein did not change his domicile from New Hampshire to
Maryland. Rather. Mr. Havenstein always considered New Hampshire to be his domicile since
True and correct copies of New to Maryland Titling and Registering Your Vehicle Information and New to
Maryland Driver Licensing Information, made available by the Maryland. Department of Transportation, Motor
Vehicle Administration at http:.'www.mva.maryland.gov/vehicles/re4istration,'new-to-mar),Iand.htm and
http:1;www.mva.marvland.gov,driversiapply'new-to-rnarvland.htm respectively, are attached hereto as Exhibit B.
he moved to New Hampshire in 1999 and always intended to return to his home in New
Hampshire after his temporary employment ended.
27. After his temporary employment with BAE Systems, Inc. ended in 2009, Mr.
Havenstein intended to return home to New Hampshire, but received an offer to serve as CEO of
Science Applications International Corporation ("SAIC").
28. Mr. Havenstein accepted the position with SAIC and began work with it on
September 21, 2009. He remained in this position until he retired on March 1, 2012. En this
position, Mr. Havenstein continued to maintain a temporary residence in Maryland and
continued to commute to work from Alton, New Hampshire, returning to Alton to be at home
with his wife most weekends, holidays, and whenever else possible.
29. While temporarily residing in Maryland for work, Mr. Havenstein did not change
his voter registration, but remained registered to vote in Alton, New Hampshire and, in fact, did
vote in Alton on numerous occasions, either in person or by absentee ballot. He has never voted
anywhere but New Hampshire in the last 15 years since he established his domicile in New
Hampshire.
30. While Mr. Havenstein temporarily resided in Maryland for work, Mr.
Havenstein's wife. Judy, also continued to live in their home in Alton, New Hampshire. where
she continued to be active in various local civic organizations, including the Barnstead-Alton
Republican Committee and the Belknap County Republican Committee. Mr. Havenstein
continued to commute home to New Hampshire to be with his wife, son, and grandchildren
during this time.
31. While temporarily residing in Maryland for work. Mr. Havenstein also continued
to pay property taxes in New Hampshire. Additionally, he and his wife have tiled their federal
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income tax returns from New Hampshire every year for the last 15 years, including the years
2006-2013. True and correct copies of Mr. Havenstein's Federal Income Tax Returns (2006-
2013) are attached hereto as Exhibit D.
32. While temporarily residing in Maryland for work, Mr. Havenstein continued to
pay the Interest and Dividends tax in New Hampshire. The New Hampshire Interest and
Dividends tax applies to "inhabitants and residents" of New Hampshire. RSA 77:3. True and
correct copies of his New Hampshire Interest and Dividends tax returns from 2006-2009 and
2012 are attached hereto as Exhibit E.
33. While temporarily residing in Maryland for work, Mr. Havenstein's monthly bank
statements and Statements of Interest Income from TD Bank, N.A., continued to be sent to Mr.
Havenstein's Alton, New Hampshire address.
34. While temporarily residing in Maryland for work, Mr. Havenstein also maintained
his bank account in New Hampshire and never changed the address on his personal checks from
his home in Alton, New Hampshire. Mr. Havenstein's payroll checks from BAE Systems, Inc.
and later SAIC were direct deposited into this New Hampshire bank account.
35. While temporarily residing in Maryland for work, Mr. Havenstein also retained
the New Hampshire telephone number associated with his personal cellular telephone.
36. While temporarily residing in Maryland for work. Mr. Havenstein also retained
his local New Hampshire primary care physician, eye doctor, and dentist and would attend
routine appointments with them.
37. While temporarily residing in Maryland for work, Mr. Havenstein also continued
his involvement in community service and philanthropy in New Hampshire.
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38. For example, Mr. Havenstein served as a board member of FIRST (For
Inspiration and Recognition of Science and Technology) from 2006 to 2010 and, in 2010, served
as chairman of the organization. FIRST is a non-profit organization based in Manchester, New
Hampshire.
39. Mr. Havenstein has also donated funds to many local charitable organizations.
Most notably, Mr. Havenstein has been a long-time supporter of the Northern New England
Chapter of the Juvenile Diabetes Research Foundation and has been the principal sponsor of the
foundation's annual Granite Gala, which is held in New Hampshire, for the last 12 years.
40. While temporarily residing in Maryland for work, Mr. Havenstein also kept all of
his personal items of significance (especially items that have sentimental value to him) at his
home with his wife in Alton, New Hampshire and did not relocate those items to Maryland.
41. Finally, though Mr. Havenstein temporarily resided in Maryland for work for a
period of time, Mr. Havenstein always intended his domicile to be his home with his wife in
Alton, New Hampshire; always intended his work situation in Maryland to be temporary; and
always intended to return to Alton, New Hampshire when he had completed his work outside of
New Hampshire.
42. In early 2012, after Mr. Havenstein resigned his position with SAIL, he sold his
condominium in Maryland and moved back to his home full-time in Alton, New Hampshire.
43. Mr. Havenstein has lived the majority of the last two years in his home in Alton,
New Hampshire with his wife. He has remained registered to vote, and has voted, in Alton, New
Hampshire during that time. He has also continued to pay his New Hampshire and federal taxes
in and from his home in Alton. New Hampshire.
REQUEST FOR RULING
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44. Part II, Article 42 of the New Hampshire Constitution provides in part that "no
person shall be eligible to th[e] office [of Governor], unless at the time of his election, he shall
have been an inhabitant of this state for 7 years next preceding ....
45. Part [I, Article 30 of New Hampshire Constitution provides that "every person,
qualified as the constitution provides, shall be considered an inhabitant for the purpose of being
elected into any office or place within this state, in the town, or ward, where he is domiciled."
46. RSA 21:6 similarly provides that -[a] resident or inhabitant or both of this state
and of any city, town or other political subdivision of this state shall be a person who is
domiciled or has a place of abode or both in this state and in any city, town or other political
subdivision of this state, and who has, through all of his actions, demonstrated a current intent to
designate that place of abode as his principal place of physical presence for the indefinite future
to the exclusion of all others.-
47. For decades, the New Hampshire Supreme Court has similarly defined one's
domicile as follows:
The place of one's domicil is the place of his home. In the ordinary acceptation, it is
where he lives and has his home. It is the place in which, both in fact and intent, the
home of a person is established, without any existing purpose of mind to return to. a
former home. It is the place which the fact and the intent, combining with one another,
gravitate to and centre in as the home. To acquire a domicil. residence and the intention
to make it the home must concur. Once acquired, actual residence is not indispensable
for its retention; it may be retained by an intention not to change it. An existing domicil
is not changed or lost by a departure from it for a temporary purpose, or with an intention
of returning.
Foss v. Foss, 58 N.H. 283, 284 (1878).
48. These authorities make clear that domicile is acquired by actual residence and an
intention to remain indefinitely and that domicile, once acquired, is not lost unless there is a
specific intention to change it. See, e.g., Bailey v. Bailey, 93 N.H. 259, 261 (1945) ("A domicile
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once existing continues until another is gained, and whether or not a new domicile has been
acquired is primarily a question of fact under all the circumstances of the particular case);
Concord v. Rumney, 54 N.H. 423, 427 (1864) ("To make a place the home of a person, two
things are essential actual residence and an intention to remain indefinitely; in other words, a
general intention to remain, with no definite purpose to remove elsewhere. If a home is once
acquired, it will not be lost by any temporary absence).
49. The BLC's decisions also adopt a similar definition of domicile and indicate that
the preeminent factor in determining domicile is the intent of the individual himself See, e.g.,
Residency Challenge of Anne C. Grassie, BLC 2012-7 (Sept. 21, 2012); Petition of Sean
Mahoney, BLC 2006-2 (July 6, 2006); N.H. Democratic Party v. BLC (Oct. 2,
2002); Petition of N.H. Republican State Committee, BLC (Sept. 29, 2000); Wright v.
Houlahan, BLC (Aug. 3, 1994).
50. Moreover, RSA 655:2 provides that Itio hold any elective office in the state, a
person must have a domicile in the state. Registration to vote or voting in another state during
the relevant time period shall create a presumption that a person does not have a domicile in this
state.- The converse is also true: if registering to vote or voting in another state creates a
presumption that a person is not domiciled in New Hampshire, maintaining one's voter
registration and actually voting in New Hampshire while temporarily absent from the state
creates a presumption that one's domicile remains the State of New Hampshire.
51. As the facts and supporting documentation attached to this verified petition
demonstrate. Mr. Havenstein acquired his domicile in New Hampshire in 1999 and never
manifested an intention to change or abandon it since.
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52. Specifically, in 1999, Mr. Havenstein moved to New Hampshire, took up actual
residence in the state, and intended to make it his home for the rest of his life.
53. While Mr. Havenstein was temporarily residing in Maryland for work, he never
manifested an intention to change or abandon his New Hampshire domicile and, in fact, returned
home to his wife in Alton, New Hampshire most weekends, holidays, and any other times he
could do so. In other words, Mr. Havenstein's home in Alton, New Hampshire remained his
family household; the one place Mr. Havenstein considered his true home and to which he
always intended to return.
54. Mr. Havenstein's intent in this regard was made manifest by the fact that once Mr.
Havenstein resigned his out-of-state position with SAIC, he sold his Maryland condominium and
moved back full-time to the home he and his wife had built in Alton, New Hampshire.
55. In short, Mr. Havenstein acquired his domicile in New Hampshire in 1999,
always intended New Hampshire to be his domicile even while he was temporarily residing in
Maryland for work, and never manifested an intention to relinquish his home in Alton, New
Hampshire as his domicile since building and moving into it.
56. Accordingly, based on the verified facts contained herein, the supporting
documentation attached to this petition, and the applicable law, Mr. Havenstein has been an
inhabitant of New Hampshire for at least the last seven years and is therefore qualified to run for
and hold the office of Governor of the State of New Hampshire.
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WHEREFORE, Mr. Havenstein respectfully requests that the BLC issue an order:
A. Scheduling an expedited hearing on this petition;
B. Declaring that he meets the seven-year residency requirement to hold the office of
Governor of the State of New Hampshire as set forth in Part II, Article 42 of the
New Hampshire Constitution and RSA 655:5; and
C. Granting such further relief as the BLC deems just and necessary.
Respectfully submitted,
WALTER P. HAVENSTEIN,
By his Attorneys,
NIXON BODY LLP
Dated: June 11, 2014
David , cmanzo, Esq., N.H.
Anthony J. Galdieri, Esq., N.H.
900 Elm Street, 14th Floor
Manchester, NH 03101-2031
TEL: (603) 628-4000
dvicinanzo@nixonpeabody.com
agaldieriitinixonpeabody.com
o. 9403
o. 18594
VERIFICATION
I. Walter P. Havenstein, being duly authorized, on oath, declare and verify that the facts
set forth in the foregoing Verified Petition are true and accurate to the best of my knowledge and
belief.
FURTHER the Affiant sayeth not.
Date: June 11. 2014
avenstein
.........
Subscribed to and sworn before me on..-ep:
z. .-.:
60/
My Commission Expires: May 26, 2015
this I I th day of June 2014:
Chary an, Notary Public
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V David . tcinanzo, Esq.
CERTIFICATE OF SERVICE
I, David A. Vicinanzo, Esq., hereby certify that a copy of the Verified Petition of Walter
P. Havenstein has been this 1 day of June, 2014, provided to The New Hampshire
Democratic Party, 105 N. State Street, Concord, NH 03301; Kathleen N. Sullivan, Esq.,
Wadleigh, Starr & Peters, PLLC, 95 Market Street, Manchester, NH 03101; Governor
Margaret Hassan, Office of the Governor, State House, 107 North Main Street, Concord, NH
03301; and Hemingway for Governor, 1850 Elm St. Manchester, NH 03104; by United States
mail, first class, postage prepaid.
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EXHIBIT A
"fly Commission Expires:
AFFIDAVIT OF PURCHASER REGARDING
EXEMPTION FROM RECORDATION TAN
(MONTGOMERY COUNTY)
After being duly sworn, the undersigned Purchaser(s) / Grantee(s) depose and say the following
under oath pursuant to Montgomery County Code, Chapter 52, Section 52-16B (Taxation)
1. The undersigned is / are the Grantee(s) of real property located at:

Address: 4821 Montgomery Lane, Unit 401, Parking G2-22 & 02-23, Bethesda,
MD 20814-5301
being more particularly described as Lot/Unit/Parcel 401, Block ,
Subdivision/Condominium EDGEMOOR CONDOMINIUM RESIDENCES,
Montgomery County, Maryland.
The Purchaser(s) I Grantee(s) hereby swears of affirms under the penalty of perjury
that the property herein conveyed is intended to be used as my/our principal
residence by actually occupying the residence for at least seven (7) of the next twelve
(12) months immediately after the property is conveyed.
3. This Affidavit is being executed in order to obtain an exemption from the Recordation
Tax payable to Montgomery County, Maryland on the first $50,000.00 of consideration
stated in an instrument of writing for residential improved owner-occupied real property
pursuant to the aforesaid statute.
STATE OF MARYLAND
COUNTY OF MONTGOMERY, TO WIT;
I Hereby Certify, That on this 4th day of January, 2007: before me, the subscnter, a Notary Public of the
State aforesaid, persona), appeared Walter P. Havenstein and Judith P. Havenstein known so me :or
satisfactorily proven) to be the person wnose name subscribed to the within nstrument and adimowtedged the foregoing
"Deed to be tnater act, and in my presence signed and sealed the same.
IN WITNESS WHEREOF, I hereunto set my hand and official seal.
P JOY SIEGEL
Notary Pi State of Maryland
County ,of Montgomery
Corarniasicr bpres Mardi L2007
FILE NUMBER: PJS061223R
principal residence.
rest
P. JOY SIEGEL
Notary Public, State at Maryland
County of Montgomery
try COMMOS ErpeteSMadt1,2001
AFFIDAVIT OF GRANTEE(S) AS
FIRST-TIME MARYLAND HOME BUYER(S)
The undersigned each state under oath as follows:
l. Each of the undersigned is a Grantee of residentially improved real property
located at 4821 Montgomery Lane, Unit 401, Parking G2-22 & G2-23, Bethesda, MD
20814-5301,
being more particularly described as LOT , BLOCK , EDGEMOOR
CONDOMINIUM RESIDENCES
Montgomery County , Mary-land.
2. Each of the undersigned is:
(a.) a first-time Maryland home buyer, defined as an individual who has never
owned in the State residential real property that has been the individual's principal
place of residence, who will occupy the property as Grantee's principal residence;
or
(b.) a co-maker of guarantor of the purchase money mortgage or purchase money
deed of trust on the property who will not occupy the property as Grantee's
STATE OF MARYLAND
COUNTY OF MONTGOMERY, TO WIT;
I Hereby Certify, That on this 4th day of January, 2007, t+efare me. the subscriber, a Notary Public of the State
aforesaid, cersonally appeared Walter P. Havenstein and Judith P. Havenstein knew to me (Or satisfactority
oroueni to be the person whose name is subscribed to the within instrument and acknowledged the foregoing Deed to be hasher
ad, and in my presenos signed and sealed the same.
IN WITNESS WHEREOF. I hereunto set my hand and official seat
FILE NUMBER: PJS061223R
EXHIBIT B
'Print This Pale http://www.mva.mary and.gov/se/utilldisplay_mod.cfm?MODULE=.-
New to Maryland Titling and Registering Your Vehicle Information
As a new resident of Maryland you must register your vehicle within 60 days of moving to
Maryland. If you delay beyond 60 days, you will not be eligible for a tax credit for any titling tax
paid in another state, and you may be subject to a citation for an out of state registration.
Please Note: If an owner of a vehicle originally titled in Maryland obtains a title for the vehicle in
another state in the same name, and returns to Maryland, it may be registered by surrendering the
foreign title and securing a Duplicate Maryland Title. There is a fee for a duplicate title.
Titling Your Vehicle
You can apply for a Maryland title, and registration, in person at any of the MVA's full service
branch offices. You also can mail the documents to the MVA's Out-of-State Title Unit, 6601 Ritchie
Highway, Glen Burnie, MD 21062, or go to an MVA licensed taq and title service where they will
assist you in applying.
Typically, you will need to submit the following forms to obtain a title for your vehicle:
Proof of ownership- This is the vehicle's existing title that identifies you as the owner. If
there is a lien against your out-of-state title:
o First, contact the MVA at the Customer Service Center at 1-410-768-7000.
o If you do not have the title document or certificate, the MVA will provide you with a
letter (form #VR-056) to send to your lien holder requesting the title(s) be sent to the
MVA. Note: Please have the following information for the letter: Name of vehicle
owner, MD address, phone number, VIN number, year, make of vehicle,lien holder's
name, lien holder's address, state where currently registered/titled and lien account
number.
o Upon receipt of the title documents(s), the MVA will write or call you to inform you that
we have received the title(s). We will inform you of the excise tax due and ask you to
send your completed Application for Certificate of Title (form #VR-005), the MD Safety
Inspection Certificate, and payment (check or money order made payable to the MVA)
to the MVA. The check should include payment for the following:
Title fee
Fee to record the lien
Excise tax and taq fees
Application form - The Application for Certificate of Title (form #VR-005) can be used to apply
for both the vehicle's title and registration. Be sure to include your insurance information.
Your policy must conform to Maryland's minimum liability insurance requirements.
Maryland Safety Inspection Certificate - This Maryland State Police form certifies that your vehicle
meets Maryland safety standards. It is valid for up to 90 days from the date issued.
O Certificate of Inspection
A Safety Inspection is required for all used cars, trucks, tractors, trailers, motorcycles,
special equipment, and class "B" for hire vehicles being titled and registered in
Maryland. They must be inspected by a licensed Maryland inspection station, such as
automobile dealers, service stations and specialized automobile service centers. A
certificate of inspection issued by the inspection station within the previous 90 days of
the vehicle titling must accompany the Application for Title. To avoid delay, compare
the vehicle identification number (VIN) entered on the inspection certificate with the
VIN on the vehicle plus the vehicle ownership documents to make certain they agree.
Altered inspection certificates will not be accepted.
Under certain circumstances, additional information and/or forms may be required:
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I 1111, I1113 I CIS,
Proof of vehicle's value - If the vehicle's value cannot be identified by the MVA, you may need
to submit a bill of sale. For leased vehicles, a lease agreement may also be acceptable.
Lease agreement and proof of monthly lease payments (leased vehicles only) - If you have paid or are
paying excise tax to another state through your lease payments, the documents may be
needed to determine the amount of excise tax credit you may receive.
Lien information - If you borrowed money to buy the vehicle, lien information may need to be
recorded on the application. The MVA form entitled Security Interest Filing (form #VR-217)
must be used if a second lien is placed against the title.
Lien release - If your title indicates that a lien exists, you must make arrangements with the
lien holder to pay off the loan (lien) or the MVA will file the lien against your new title (i.e.,
transfer the lien).
Power of attorney - If someone other than you, the new owner, is signing the titling forms for
you, this document is required.
Note that if you also intend to register the vehicle, additional forms are usually needed
Registration requirements vary greatly by the type and intended use of the vehicle. The
requirements for most vehicles can be found in Registration - Common Vehicles.
Your title will be mailed to you regardless of how you apply. If you also register the vehicle, your
registration card, license plates and expiration stickers can be provided immediately when you
apply in person to the MVA; otherwise, these items also will be mailed to you.
Maryland Excise Titling Tax
If the vehicle has been recently purchased, the 6%excise tax is based on the greater of the total
purchase price verified by a notarized MVA Bill of Sale (form VR-181), signed by both the buyer(s)
and the seller(s) in which the actual price paid for the vehicle is stated or $640. In other cases, the
total purchase price or the valuation shown in a national publication of used car values adopted for
use by the Administration will be used to establish the tax. There is an addition or subtraction for
high or low mileage. On vehicles seven years old and older, the tax is based on the greater of the
purchase price or the minimum book value of $640.
Note: As a new resident, to comply with Maryland law and take advantage of a lower excise tax,
you must title and register your vehicle within 60 days of declaring residency in Maryland.
For vehicles less than 7 years old (Non-Residents):
Vehicle(s) titled in a state with a tax rate equal to or higher than Maryland's 6%tax rate will
cost $100.
If the vehicle is registered in a state that imposes no tax, the tax will be assessed at 6%of
the value of the vehicle.
Vehicles from a state with a lower tax rate than Maryland's 6%will be taxed at the rate of
the difference between the two states. Example: MD 6%, VA 4%, the difference is a 2%tax
rate. Minimum tax - $100. When the value of the vehicle is less than $2,000, the 6%rate will
apply.
For a vehicle over 7 years old:
Tax is based on the greater of the purchase price or the minimum of $640. The MVA may
require you to submit additional documentation to substantiate the purchase price.
For a leased vehicle:
Lease agreement and proof of monthly lease payments (leased vehicles only) If you have
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paid or are paying excise tax to another state through your lease payments,
documentation is needed to determine the amount of excise tax credit you may receive.
DriverLicensingInformationisalsoavailablefornewMarylandresidents.
3 of 3 6/3/2014 10:46 AM
Print This Page littp://www.mva.maryland.goviseiutil/display_mod.cfm'AIODULE----
New to Maryland Driver Licensing Information
Effective January 1, 2014, the MVA will implement a new process for immigrants, presenting
foreign documentation without valid accompanying United States Citizenship and Immigration
Services documentation, to obtain a driver's license, learner's permit, moped permit or
identification card (DL/ID).
Customers who are interested in obtaining one of these DL/IDs are advised to take the following
steps in preparation for the new law:
Apply for an Individual Taxpayer Identification Number through the Internal Revenue
Service, http://www.irs.00v/Individuals/General-ITIN-Information;
File Maryland Income Taxes for the preceding 2 years and obtain a certification letter that is
needed to make an appointment and present to the MVA. Click here for more information;
Apply for and obtain identity documents such as a valid, current foreign passport;
Obtain two residency documents such as copies of a residential lease, utility bill, or bank
statement; and
Study the Maryland Driver's Manual and take the Online Driver Test Tutorial to prepare for
the knowledge test.
Customers presenting foreign documentation without valid accompanying United States Citizenship
and Immigration Services documentation MUST schedule an appointment online to apply for a
Federally Non-Compliant DL / ID.
Before you make an appointment, you must have contacted the Comptroller's Office of Maryland to
obtain proof of Maryland income tax filings. You may obtain a certification letter by applying online
here or by making an appointment to visit one of the Comptroller's branch offices.
You may visit the Online Document Guide to start the process for scheduling an appointment.
Also effective January 1, 2014, all Identification cards, new Type 1 GLS Learner's permits, and any
Federally Non-Compliant DL/IDs will be mailed to your Maryland residence address on file.
Please continue to check the website for the most up to date information on this new process.
Please refer to Sources of Proof for details on the required identity and residency documentation
and instructions on how to obtain a DL/ID under this new law.
If you are a new resident of Maryland and you hold a noncommercial driver's license, you
have 60 days to obtain a Maryland Driver's License. If you hold a commercial driver's
license (CDL), you must transfer your CDL within 30 days. When applying, please bring:
Please refer to Sources of Proof for required identity and residency documentation and instructions.
New Maryland residents must obtain a Maryland Driver's License within 60 days.
You must pass a vision test.
An Out-of-State license must be a valid license or a license expired for less than one year.
The license cannot be suspended.
If licensed for less than 18 months, you will be issued a Maryland Provisional License.
If you are exchanging an Out-of-State license that has been expired for one (1) year or
more, you are required to take the knowledge and skills tests in addition to the vision test.
1. Tests may be waived for active duty military and their dependants if the issuing State grants
military extensions.
2. You can contact the State in which your last license was issued to find out if a military
I 42 6/ 3/2014 10:49 AM
CI ill.. 1lit.tv.11 NV VY U131-Mly_tlIVU.l.1.111.1vIVLJU L E-
extension is granted before visiting the MVA.
3. There is no automatic extension to all active duty military. Each State has their own
procedures and Maryland will review the procedures of the State in which the license was
issued before determining whether the transfer can be done without testing.
A valid U.S. Department of Transportation (DOT) physical card or federal/MVA waiver (if
applying for a Commercial Driver's License).
A hazardous material (HAZMAT) test is required to keep your HAZMAT endorsement (if
applying for a Commercial Driver's License).
Out-of-State learner's permits cannot be exchanged for a Maryland Learner's Permit or
License.
Titling and Registration information is also available for new Maryland residents.
2 01'2 (,/312014 10:49 AM
EXHIBIT C

fafe jaat-upsilirt,

JOHN J. BAHTHELMES
COMMISSIONER OF SAFETY
DEPARTMENT OF SAFETY
DIVISION OF MOTOR VEHICLES
STEPHEN E. MERRILL BUILDING
23 HAZEN DRIVE, CONCORD, N.H. 03305
603-227-4000 TDD Access: Relay NH 1-000-135-2064
RICHARD C. HAILEY,
DIRECTOR OF MOTOR VIA
Ma) 1' 2014
I o Whom It May Concern:
We have researched our riles and round:
Walter Havenstein, D013: 04/24/1949 and Judith Ilavenstein, D013:
07/02/1949, of 112 Dewitt Drive, Alton, NH 03809, have consistently and
consecutively registered motor vehicles in the State of New Hampshire since
2005.
If You should have any questions. please reel lice to contact the Bureau Dr
RCOStrZIII011,ti
at UO3-27 I _4030.
Sincerely.
I 411; \ f.11 lc
1 1'
' I
; ',o
EXHIBIT D
9a
7 Wages, salaries, tips, etc. Attach Form(s) W-2
3a Taxable interest. Attach Schedule B it required
b Tax-exempt interest. Do not include on line 8a f 8b1

9a Ordinary dividends. Attach Schedule B if required
b Qualified dividends (see nstrs) 9 bi
ons, trusts, etc. Attach Schedule E ..1 17 17 Rental real estate, royalties, partnerships, S corpora
18 Farm income or (loss). Attach Schedule F
19 Unemployment compensation
20a Social 'security tenelits 20a1 3 b Taxable amount (see nstrs)
10
11
w" 37
35 r, i'orriesnc production activities deduction. Attach Form 3903 j 35
36 Add lines 23 31a and 32 . 35
37 Subtract line 36 from line 22. This is your adjusted gross income
FDIA0112 11/07/06 Farm 1040 (2006)
BAA For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see instructions.
For the year Jan I Dec 31, 006, or other tax year beginning
Your tirst name MI Last name
, 2006, ending
Walter P HAVENSTE IN,
II a ;amt return, spouse's rust name Mi Last name
Judith El RAVENS TE IN
Home address (number Pori street). If you have a P.O, box, sae Instructions.
112 DeWitt Drive
Sr.
DriY, trwn or oast r.rtice. If you have a foreign address, see instructions.
Alton
State ZIP code
NH 03809
Filing Status
Check only
one box.
1 I Single
2 X Married filing jointly (even if only one had income)
3 LI Married filing separately. Enter spouse's SSN above & full
name here .. "" 5 1
f
Qualifying_widow(er) with dependent child (see instructions)
You must enter your
social security
number(s) above. A
Checking a box below will not
change your tax or refund.
~~ You E Spouse
Department at the Treasury Internal Revenue Service
Form 1040 U.S. Individual IncomeTax Return 2006
jOk Check here if you, or your spouse if filing saintly, want $3 to go to this fund? (see instructions)
Apartment no.
4
Li
Head of household (with qualifying person). (See
instructions.) If the qualifying person is a child
but not your dependent, enter this child's
name here .
Label
,Sera instructions)
Use the
IRS label.
Otherwise,
please print
or type.
Presidential
Election
Campaign
99) IRS Use On Do not write or staple in this space
, 20 cme No. 1545-0074
Your social security nisnber
Spouse's social security number
30 Penalty on early withdrawal of savings 4 30
31 a Alimony paid b Recipient's SSN .. j 31 a
32 'RA deduction (see instructions) 32
33 Student can interest deduction (see instructions) 133
34 Jury duty pay you gave to your employer 134
36
Exemptions
If more than
tour dependents,
see instructions.
,
6a ',
bS

Yourself. If someone can claim you as a dependent, do not check box 6a
Spouse
_
c Dependents:
(1) First name Last name
(2)Dependent's
social security
number
(3) Dependent's
relationship
to you
(4) i li
qualifying
chikt for child
tax credit
(see I mil's)
il
11
11
d total number of exemptions claimed
10 Taxable refunds, credits, or offsets of state and Iscat income taxes (see instructions)
11 Alimony received
12 Business income or (loss). Attach Schedule C or C-EZ
13 Capital gain or (loss). Mt an D if rend, If not reed, ck here
14 Other gains or (tosses). Attach Form 4797
15 a IRA distributions
16a Pensions and annuities
b Taxable amount (see instrs)
14
12
13
18
19
Eloses checked
on Fie and 6b
No. al chlidnen
on Sc who:
lived
with you
did not
live with you
due to divorce
or separation
(se* inland . .
Dependents
an Sc riot
(intend above .
Add numbers
on lines
throve
2
2
7
8a
21 Other income
r22.4_
In
mamma
22 Add the amounts the far right column for lines 7 through 21. This is your total income. 22
23 Archer MSA deduction. Attach Form 3853
I 23
24 Certain business expenses of reservists, performing artists, and fee-basis
covernfrent :fficials. Attach Farm 2106 or 2IC6iE1 ............
Z5 Health savings account deduction. Attach Form 8889 25
26 Moving expenses. Attach Form 3903 26
27 Ore-half of seif-employment tax. Attach Schedule SE 27
28 Self-employed SEP, SIMPLE, and qualified plans 28
29Self-employed teaith insurance deduction (see instructions)
29
24
Income
Attach Form(s)
W-2 here. Also
Attach Forms
W-2G and 1099-It
if tax was withheld.
If you did not
-Jet a W-2,
see instructions,
Enclose, hut do
not attach, soy
payment_ Also,
please rise
Form 1040-V.
Adj usted
Gross
income
15b
16b
20 b
15a
16a
Label
(See instfuctionsi)
Use the
IRS label.
Otherwise,
please print
or type.
Presidential
Election
Campaign
4 Li Head of household (with qualifying person). (See
name here .
2
3
2
7
Income
Attach Form(s)
W-2. here. Also
attach Forms
W-2G and 1099-R
If you did not
get a W-2,
see instructions.
15b
Department of the Treasury Internal Revenue Service
Form 1040 U.S. Individual Income Tax Return 2007 IRS Use Only Co not write or staple in the space.
, 2C07, ending an I - Dec 31, 2007, or other tax year bet nrong_
, 0 For the yea OMB No. 1545.0074
Mt Last name Your social security number YOU first Paine
P HAVENSTE IN, Sr. Walter
Last name , f a mint return, spouses lest name Mt
Spouse's soda security number
111111111111111111111111111
Judith P HAVENSTE IN
Home address (number and street). If you have a P.O. box, see instructions,
112 DeWitt Drive
You must enter your
social security
A number(s) above. A
apartment no.
City, town or post office. it you have a foreign address. see
Alton
nstructionS. State ZIP code
NH 0 38 0 9
Check here it you, or your spouse if filing jointly, want $3 to go to this fund? (see instructions) ....... You 11Spouse
Single
Married filing jointly (even if only one had income)
Married filing separately. Enter spouse's SSN above
name here ..
Filing Status
Tc.
full
Check only
one box. 5 Qualifying widow(er) with dependent child (see instructions)
dependent, do not check box 6a
Boxes
on 6a and 6b
checked
6a Yourself. It someone can claim you as a
b X Spouse
Exemptions
Ho. of children
(4)
if
on 6c who:
qualifying ' lived

child for chili with you
tail credit did not

(see
tifsIrs) live with you
due to divorce
L or separation
instrs) .
Oependente
ri on 6c not
entered above
Arid numbers
on lines
above
(2) Dependent's
social security
number
(3) Dependents
relationship
to you
c Dependents:
(1) FirstnameLast name
if more than
four dependents,
see instructions.
2 d Total number of exemptions claimed
8a Taxable interest. Attach Schedule B if required
b Tax-exempt interest. Do not include on line 8a 8b1
b Qualified dividends (see instrs) I 9b1
al1111111111111111t
8a
9a
10 Taxable refunds, credits, or offsets of state and local income taxes (see instructions)
11 Alimony received
10
11
12
13Capital gain or (loss). Att Sch 0 if reqd. if not reqd, ck here
14 Other gains or (losses). Attach Form 4797
15a IRA distributions 15a
13
14
bTaxable amount (see instrs) 16a 16 b
17 Rental real estate, royalties, partnerships, S corporations, trusts, etc. Attach Schedule E
20 a Social security benefits 20 a b Taxable amount (see instrs)
21Cther income
17
18 Enclose, but do
not attach, any
payment. Also,
.dease use
Farm 1040-V.
19
20 b
22 Add the amounts in fhe far right column for lines 7 through 21
23 Educator expenses (see instructions)
24 Certain rosiness menses of reservists, performing artists, and feebasis
government officials. Attach Farm 2106 or 2106-EZ
25 Health savings account deduction. Attach Form 8889
26 Moving expenses. Attach Farm 3903
27 One-haif of selfemployment tax. Attach Schedule SE
28 Self-employed SEP, SIMPLE, and qualified plans
29 Self-employed health insurance deduction (see instructions) ...
30 Penalty on early withdrawal of savings
31a Alimony raid b Recipient's SSN
This is your total income
23
Adj usted
Gross
Income
24
25
26
27
28
29
30
31a
32 IRA deduction (see instructions) ..... , ........
33 Student loan interest deduction (see instructions)
34 Tuition and fees deduction. Attach Form 3917
35 Domestic production activities deducton. Attach Form 3903
36 Add lines 23 31a and 32 - 35
37
32
33
34
35
36
37 alliffiffalla
Subtract line 36 from !ire 22. This is your adj usted gross income .
FDIA0112 12;06/07 Form 1040 (2007)
BAA For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see instructions.
orkev rearuary '10013)
.. IIMAJIIIIC I aw neturii vie
See separate instructions.
CMS No. 1545-0074
This return is for calendar year 1" 200 8 , or fiscal year ended 0.
Note. Allow 8-12 weeks to process Form 1040X.
Your first name MI Last name Your socird security number
P Havenstein S
joint return, spouse's first name Mt
Last name
Judith P Havenstein
Home address (no. and sheet) or P.O. boa if mail s not delivered to your home
Apt no. Phone number

112 DeWitt Drive
City. town or post office. If you have a foreign address, see instructians.
Al ton
late ZIP code
NH 0 3 809
Please
print
or
type
Walter
A
If the address shown above is different from that shown on your last return filed with the IRS, would you like us to change
it in our records?
B Filing status. Be sure to complete this line. Note. You cannot change from joint to separate returns after the due date.
On original return Single X Married filing jointly
On this return Single Married tiling jointly
11=1,
If the qualifying person is 3 child but no ndent, see instructions
Married lihng separately
Married hling separately
Head of household
Head el household'
KYes No
Qualifying widow(er)
Qualifying wiclow(er)
A Original
amount or as
previously adjusted
(see instructions)
BNet change
amount of increase
or (decrease)
explain in Part II
CCorrect
amount
Tax
Lia.
bility
Use Part It on page 2 to explain any changes
Income and Deductions (see instructions)
1Adjusted gross income (see instructions)
2 Itemized deductions or standard deduction (see instructions)
3 Subtract line 2 from line 1
4 Exemptions. If changing. fill in Rads I and II on page 2 (see instructions)
5 Taxable income. Subtract line 4 from line 3
6 Tax (see extractions). Method used in column C . QDCGTW
7 Credits (see instructions)
8 Subtract brie) from line S. Enter the result but not less than zero
9 Other taxes (see instructions)
10 Total tax. Add lines 8 and 9 .............
Pay-
ments
11Federal income tax withheld and excess social security and
tier 1 RRTA tax withheld. If changing, see instructions
12 Estimated tax payments, including
amount applied from prior years return
13 Earned income credit (EIC)
14 Additional child tax credit from Form 8812
15 Credits: Recovery rotate; federal telephone excise tax; or from Forms 2439,
a136, .5405, .45, or 1 (refundable credit only)
Amount paid with request for extension of time to file (see ins ructions)
17
18
16
17 Amount of tax paid with original return plus additional tax paid after it was filed
18 Total payments. Add lines 11 through 17 in column C
6
Refund or Amount You Owe
19 Overpayment, if any, as shown on original return or as previously adjusted by the IRS
20 Subtract line 19 from line 18 (see instructions)
21Amount you owe. If line 10, column C, is more than line 20, enter the difference and see instructions
22 If line 10, column C, is less than line 20, enter the difference
23 Amount of line 22 you want refunded to you
24 Amount of line 22 you want applied to your estimated tax 24
19
Sign Here
Joint return?
Sere instrs.
Keep I copy
CA
Under penalties of perjury, I declare that I have filed an original return arid that I have examined this amended return, preluding accompanying schedules and
statements, arid to the Pest at my knowledge and belief, this amended return is true, correct, and complete. Declaration of preparer than taxpayer) is
based en ail information of which the preparer has any knowledge.
Cate
Spouse's signature. It a joint return, both must s.gn :ale

lour signature
Paid
Preparer's
Use Only
Preparer's
signature
Firm's name
(or yours if
self e mo toyed),
address, and
Zie code
Self prepared
Date
Check if self. n
employed !
EIN
i1 Preparers SSN or PTIN
Phone no.
BAA For Paperwork Reduction Act Notice, see instructions. FDIA 1812 CZ/20109 Form 1040X (Rev 2-2009)
Boxes checked
on ea sod 6b.
No. of children
on Sc who:
lived
with you . .
did not
tive with you
due to divorce
or separation
(see Intent
Dependents
on Sc not
entered above
Add numbers
on ante
above . . . ~~

2

ea X Yourself. If someone can claim you as a dependent, do not check box 6a.. ......
b X Spouse
c Dependents:
(2) Dependent's
social security
number
(3) Dependent's
relationship
to you
(4) /4
((ualifying
child for (tuld
as : mlit
(see ;mite)
n
n
n
Capartment of he Treasury Intemsi Revenue Senna'
Form 1040 U.S. Individual Income Tax Return 2009 (99) IRS Use Only Do not woe, or staple in Ibis space.
, 20 For the year Jan 1- Cec 31, 2009, or other tax year beginning , 2009, ending OMBNo. 1545-0074
Your first name Mi Lost mane
WALTER P FIAVENSTEIN, SR
If a j oint return, spouse's first name
JUDITH
Home address (number and street). If you nave a P.O. bog, see instruction,
Apartment no.
112 DeWitt Drive
City, Imien or post office. If you have a fornittn ounress, see instructions.
Slate ZIP code

Altcn
NH 0 3 8 0 9
)110, Check here if you, or your spouse if filing jointly, ward S3 to go to Out fund? (see insinxdons)
Your social security number
Yousomcluasitseec nutehrtrur
A number(s) above. A
charge o your tax a srephind ouse .
~~
E
Label
see insinctIons.)
Use the
IRS label.
Otherwise,
please print
or type.
Presidential
Election
Campaign
MI Last name
P HAVENSTEIN
Filing Status
1
2
3
X
km%
Single
Marled tiling separately. Enter spouses SSN above & lull
name here.
4 Head of household (with qualifying person). (See
name here e-
Check only
one box.

n Qualifying widow(er) with dependent chid (see instructions)
Exemptions
If more
than four
dependents,
see instructions
and check here PO
d Total number of exemptions claimed
Adj usted
Gross
Income
B a Taxable interest. Attach Schedule B if required
b Tax-exempt Interest. Do not include on line 8a I Obi

9 a Ordinary dividends. Attach Schedule B if required
b Qualified dividends (see instrs) 9 bl
13 Capital gain a (toss). Att Sch D if regd. If not rciqd, ck here
15a IRA distributions .... 15a
18a Pensions and annuities . 113a
17 Rental real estate, royalties, partnerships. S corporations, trusts, etc. Attach Schedule E
18 Farm income or (loss), Attach Schedule F
19 L'ixrricicyriiixeit compersetlart in 9.911. of 12.400
,ed point (see inlInJeJalli)
Add the amounts in the far right column for tines 7 through21. This is Your total Income .
Educator expenses (see instructions)
Certain business expenses of reservists, performing artists, and lee-basis
government officials. Attach Form 2106 or 2106..E7
25 Health savings account deduction. Attach Form 8889
26 Moving expenses. Attach Form 3903
27 One-half of self-employment tax. Attach Schedule SE . .
Income
Attach ForM(s)
'N..2 here. Also
attach Forma
'N-2G and 1099-R
If you chi not
get a IN-2,
see instructions.
Enclose, but do
not attach, any
payment. Also,
;Lease use
Form 1040-V.
.CI
bTaxable amount (see instrs)
20 a Social security benefits. . . 20 a b Taxable amount (see instrs)

21 Other income
22
23
24
23
24
25
26
27
28
7
8a
MIN
9a
10
11
12
14
13
15b
16b
18
19
17
20 b
21
sn
22
10 Taxable refunds, credits, Of offsets of stale and local income taxes (see instructions)
11 Alimony received
29 Self-employed health insurance deduction (see instructions)
29
30 Penalty on early withdrawal of savings . ....... .
30
31a Alimony paid b Recipient's SSN. P.
31 a
32 IRA deduction (see instructions)
32
33 Student loan interest deduction (see instructions)
33
34 Tuition and fees deduction. Attach Fcrm 8917 34
35 Domestic production actvities deduction. Attach Form 0903
35
38 Arid :Ines 23- 31a and 32 - 35
36
37Subtract line 36 from line 22. This is your adjusted gross Income ~~37
9AA For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see Instructions.
1,3150112 .:(9117:69'norm
(99) IRS Use Only Do nal write or staple in this space.
Department of the Treasury Internal Revenue Service
Form 1040 U.S. Individual Income Tax Return 2010
c Dependents:
10 Taxable refunds, credits, or offsets of state and local income taxes
11 Alimony received
12
13
business income or (loss). Attach Schedule C or C-EZ
Capital gain or (loss). Att Sch D if reed. If not reed, ck here
15a b Taxable amount
23 23 Educator expenses
Adj usted
24 Curtain huntress expenses of reservists, performing artists, and fee-basis
Gross Jovernment officials, Attach Form 210 or 2106-E2 ...... . .
Income 25 Health savings account deduction. Attach Form 8889
27 One-half of self-employment tax. Attach Schedule SE
28 Self-employed SEP, SiMPLE, and Qualified plans
29 Self-emoloyed health insurance deduction
34
31a Alimony paid b Recipient's SSN
32 IRA deduction
33 Student loan interest deduction
34 Tuition and fees. Attach Form 9917
35 Domestic production activities deduction. Attach Form 3903
36 Add lines 23- 31a and 32 35
37 Subtract line 36 from line 22. This is your adjusted gross income
3 a
Name,
Address,
and SSN
See separate
instructions.
Presidential
Election
Campaign
P'or the year Jan I - Ceo 31, 2010, or other tax year beginning , 2010, ending , 20
Your first name MI Last name
WALTER P H.A.VENS TE , Sr.
1 a j oint return, spouse's first name Mt Last name
JUDITH P HAVENSTEIN
Home address (number and street). if you have a P.O. box, see instructions.
112 DEWITT DRIVE
Apartment no.
City, Lawn or past office. if you have a torerOn address, see msfructians.
ALTON
State
N14
ZIP code
03909
Check here if you, or your spouse if riglorntly, want 13to go to this fund/
2 IX
3
Filing Status
Check only
one box.
Single
Married filing separately. Enter spouse's SSN above & full
Time here ..
4 Head of household (with qualifying person). (See
instructions.) If the qualifyingperson is a child
name here .
5
n
Qualifying widow(er) with dependent child
OiMEI No. 1545-0074
Make sure the SSN(s)
, above and on line fic
are correct.
Checkinga box below will not
k" El You KSpouse
(4) 7rf
chid let
nrh
fien I hr
tS7
(see instrS)
n
Boxes checked
on 6a arid 6b
No. of children
on 6c who:
lived
with you
did not
rive with you
duo to divorce
or separation
(see instrs) , ,
Dependents
on 6c not
entered above
Add
on lines
above
2
6a - Yourself. pc Yourself. If someone can cla
b ;X Spouse
(2)Cependent's
social security
number
(3) Dependent's
relationship
to you
17 Rental real estate, royalties, partnerships, S corpora
20a Social security benefits 120 a
b Taxable amount
ons, trusts, etc. Attach Schedule E
b Taxable amount
21 Other income SUBSTITUTE PAYMENTS FROM FORM 10 99MISC
16a
m you as a dependent, do not check box 6a
8a Taxable interest. Attach Schedule B if required
b Tax-exempt interest. Do not include on line 8a
b Qualified dividends
15a ;RA distributions ............
22 Combine the amounts in lhe far opt column for lines 7 through 21. This is your total income
Exemptions
3AA For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see separate instructions.
24
25
26
27
28
29
30
32
35
FDIA0112 2/22/10 Form 1040 (2010)
37 111111111111M
'f more than four
dependents, see
instructions and
check here
income
Attach Form(s)
,V-2 here. Also
ittach Forms
and 1099-R
if you did not
jet a W.2,
see instructions.
Enclose, but do
not attach, any
:)ayinent. ;Ono,
:110;15e Use
Form 1010-V.
Check only one
box.
Filing Status
1 f.:1 Single
2 Z1 Married filing Jointly (even if only one had income)
3 KMarried filing separately. Enter spouse's SSN above
and full name here. Is
4 0 Heed of household (with qualifying person), (See instructions.) If
the qualifying person is a child but not your dependent, enter this
child's name here. *
5
K
IMMO
Taxable refunds, credits, or offsets of state and local income taxes
Alimony received
Business income or (loss). Attach Schedule C or C-EZ
Capital gain or (loss). Attach Schedule D if required. If not required, check here PP.
EI
Other gains or (losses). Attach Form 4797 . .........
IRA distributions 15a
Pensions and annuities 16a
17
Rental real estate, royalt es, partnerships, S corporations, trusts, etc. Attach Schedule E
Farm income or (loss). Attach Schedule F
Unemployment compensation
Social security benefits 20a I b Taxable amount .
Other income. List type and amount SUBSTI.X192 PAYMENTS FROM FORM 1099-MISC
Combine the amounts in the far right column for lines 7 through 21. This is your total Income I.
23
Educator expenses .....
Certain business expenses of reservists, performing artists, and
fee-basis government officials. Attach Form 2106 or 2106-EZ
25 Health savings acccunt deduction. Attach Form 9889 .
27 Deductible part of self-employment tax. Attach Schedule SE
29 Self-employed health insurance deduction
31a Alimony paid b Recipient's SSN ~~
32 !RA deduction
33 Student loan Interest deduction
34 Tuition and fees. Attach Form 8917
35 Domestic production activities deduction. Attach Form 8903
38 Add lines 23 through 35
37
E 1040
Department of the TreasuryInternal Revenue Service
(99) 5
U.S. Individual Income Tax Return
261 1
OMB No.1545-0074 IRS Use OnlyDo not wrtte or staple In this space,
For the year Jan. -Dec, 31, 2011, or other tax year 2011, 20 See separate instructions.
Your first name and initial
WALTER P
Last name
HAVENSTEIN, Sr.
IIIIIIIIIIIIIIIII
if a joint return, spouse's first name and initial last
JUDITH P
name
HAVENSTEIN
spouse's social sectrity number
IIIIIIIIIIIIIIIIII
Home address(number and street). If you have a P.O.box, see instructions.
112 DEWITT DRIVE
Apt. no.
A Make sure the SSN(s) above
- and on line 6c are correct.
City, town (X poet silica,ate, and ZIP code. If you have a foreign address, also uxnplete spaces below (see instructions).
A.LTON NH 03 8 0 9
presi
Election Campaign
Check hese if you, re yeti somas if fiNng
joirtty, watt ga th ing
a b. bei
13 to
m will
not
to
ch ang
e fund,
e
ycur tax or
refund.
Ej You 0 Spouse
Foreign country name Foreign provinc coun Foreign postai code
6a Yourself, If someone can claim you as a dependent, do not check box Ba
. Spouse . .......
c Dependents:
(1) ilmt name Last rams
(2) Dependents
social security number
13) Dependents
relationship to
you
(4) i if child under age 17
quaiifying for child tax credit
(see instructional
CI
El
CI
CI
Total number of exemptions claimed
Wages, salaries, tips, etc. Attach Form(s) W-2
Taxable interest. Attach Schedule B if required
Tax-exempt interest. Do not include on line 8a .
Ordinary dividends. Attach Schedule B if required
Qualified dividends
Exemptions
If more than four
dependents, see
instructions and
check here le- r]
If you did not
get a W-2,
see instructions.
Attach Forrn(s)
V-2 here. Also
Attach Forma
W-20 and
1099-R If tax
was withheld.
Adj usted
Gross
Income
d
7
8a
b
98
10
11
12
13
14
15a
16a
17
18
19
20e
21
22
23
24
b Taxable amount .
b Taxable amount . .
29
30
31a
35
34
32
33
27
28
26
24
25
38
20b
15b
21
19
18
13
14
Ba
11
12
7
Subtract line 38 from line 22. This is your adj usted gross income ~~
______111111111111._
MOM
18. 12,_1111111.117_
3771111111.1111111p=
1 9b
Income
Enclose, but do
riot attach, any
payment. Also,
please use
Form 1040-V.
9a
10
Boxes checked
on sa and 6b
No. of children
on 6c who:
lived with you
did not live with
you due to dtverce
or separation
(see Instructions)
Dependents on So
not entered above
Add numbers an
lines above ~~
2
For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see separate instructions. BAA
Adj usted
Gross
Income
Attach Form(s)
f-2 here. Also
attach Forme
W-2C1 and
1099-R if tax
was withheld.
If you did not
get a W-2,
see instructions.
Enclose, but do
not attach, any
payment. Also,
please use
Form 1040-V.
Income
23
24
25
28
27
29
30
31a
32
33
34
35 Domestic production activities deduction. Attach Farm 8903
37
19
20e
21
22
7 Wages; salaries, tips, etc. Attach Form(s) W-2
130 Taxable interest. Attach Schedule B if required
b Tax-exempt interest. Do not Include on line Ba
b Qualified dividends .......

10
11
12
13
14
15a
16a
17
18
Social security benefits 4 20a b Taxable amount . .
Other income. List type and amount Substitute Paiment from 10 9 9 -Mi sc
'Combine the amounts in the far right column for lines 7 through 21. This is your total income Ile
Educator expenses 23
Certain business expenses of reservists, performing artists, and
àe-basis government officials. Attach Form 2106 or 2108-E2 24
Health savings account deduction. Attach Form 8689 . 25
Moving expenses. Attach Form 3903 26
Deductible part of self-employment tax. Attach Schedule SE . 27
Self-employed SEP, SIMPLE, and qualified plans 28
Self-employed health insurance deduction . 29
Penalty on early withdrawal of savings 30
Alimony oaid b Recipient's SSN ~~ 31a
IRA deduction 32
Student loan interest deduction 33
Tuition and lees. Attach Form 8917 34
Subtract line 38 from line 22. This is your adjusted gross income
Taxable refunds, credits, or offsets of state and local Income taxes
Alimony received
Business income or (loss). Attach Schedule C or C-EZ
Capital gain or (loss). Attach Schedule D if required. If not required, check here
Other gains or (losses). Attach Form 4797
IRA distributions . 15a b Taxable amount .
Pensions and annuities 160 b Taxable amount
Rental real estate, royalties, partnerships, S corporations, trusts, etc. Attach Schedule E
Farm Income or (lass). Attach Schedule F
REV 02/07/1317111111111 Form 40 2012)
37
2013
38
21
22
19
91_.A11111111r__
10
11
12
13
14
15b
18
1040
Deportment of the TreasuryInternal Revenue Service (09)
u. U.S. Individual Income Tax Return 2 0 i 2 omBNo 545-0074 IRS Use On yOo not ,.wite or staple In this space.
For the year Jan. 1-0ec.31, 2012, or other tax year beginning 2012, ending 20 See separate instructions.
Your first name and initial
WALTER P
Last name
HAVENSTEIN, SR
(pint return. Spouse's first name and initial
JUDITH P
Last name
HAVENSTEIN
p social security number
Home acdress :number and street). It you have a P.O. box, see instmctionS.
112 DeWitt Drive
Apt. no.
k Make sure the SSN(s) above
".'1and on line Sc are correct.
:.ity, town cr post office, state, and ZiP code. If you have a foreign address, also complete spaces below (see instructions).
Alton NH 03809
Presidential Election campaign
Check here if you, or your spouse if filing
;chitty, want 43 to go to this fund. Checking
a boa below wtil not change your tax or
(-And.
0 You
K
Spouse
Foreign country name Foreign provincelstatelnounty Foreign postal ode
Filing Status
Check only one
box.
1 E] Single
2 F1 Married filing Jointly (even if only one had income)
3 CI Married filing separately. Enter spouse's SSN above
and full name here. le
4 CI Head et household (with qualifying person). (See instructions.) If
child's name here. ~~
5
K
ea 2 Yourself. If someone cart claim you as a dependent, do not check box Ba
h Spouse
c Dependents:
II) First name Last name
(2) flapandenns
mustily number
(3) Dependent's
relationship to you
(4) 1 it child under age t7
gualihylng for uhild tax mutt
(see (see Instructions)
LI
is
si
Boxes checked
on tie and 6b
No. of children
on Sc who:
lived with you
did not live with
you due to divorce
or separation
(see Instructions)
Dependants on Se
not entered above
Add numbers on
fines above IP
Exemptions
If more than four
dependents, see
instructions and
check here le K
2
2
6a
Yourself. If someone can claim you as a dependent, do not check box fia
b 0 Spouse
ill Ere name Last name
c Dependents:

12) Dependents
social security number
(3)Dependents
relationship to
you
(I) V if child ewer see 17
qualifying ler child tax credit
(see instructions)
0
0
0
Boxes checked
on Bit end fib
No. of children
on fic who:
lived with you
did not live with
you due to divorce
or separation
(see instructions)
Dependents on @a
not entered above
Add numbers on
antes above liv
2
18
19
20b
21

040
Department of the TreasuryInternai Revenue Serike (99)
U.S. Individual Income Tax Return
Far the year Jan. 1-Dec. 31, 2013, or other tax year beginning
Your first name and
WALTER
it a pint return, ,iocuse s first name and initial
Last name
JUDITH e HAVENSTEIN
Home addressinumner and street). It you have a P.O. box, see instructions.
112 DEWITT DRIVE
2613
2013, ending , 20
OMB No. 1545-0074 IRS Use OnlyDo not write Or staple In this space.
See separate instructions.
Apt no.
11111111.1
Make sure the SSN(s) above
and on line Sc are correct.
name
HAVENSTEIN, Sr.
1 0 Single
2 Married filing jcintly (even if only one had Income)
3 0 Married filing separately. Enter spouse's SSN above
and full name here. te
Foreign province/state/county
Presidential Election Campaign
Check here if you, ix your spouse it Ting
jointly, want S3 to go to the fund. Checking
a box belcre will not clangs your tat or
refund.
0 You KSpew.*
4
0 Head of household (with qualifying person). (See instructions.) If
child's name here. lie
5 0 Qualifying wIdow(er) with dependent child
City, 'nwn or post office, state, and LIP coca you nave a foreign address, also compiete spaces below (s
ee erections).
.ILTCN NH 0 3 8 0 9
Foreign country ârra
Filing Status
Check only one
box,
Foreign postal ccde
d
7
0a
98
10
11
12
13
14
15a IRA distributions . 15a
18a Pensions and annuities 16a
17
18
19
20a
21
Total number of exemptions claimed
Wages, salaries, tips, etc. Attach Form(s) W-2
Taxable interest. Attach Schedule B if required
Tax-exempt interest, Do not include on line ea
Ordinary dividends. Attach Schedule B if required
Qualified dividends ...... ,
Taxable refunds, credits, or offsets of state and local income taxes
Alimony received
Business income or (loss). Attach Schedule C or C-EZ ..
Capital gain or (loss). Attach Schedule 0 if required. If not required, check here ~~
Other gains or (losses). Attach Form 4797
Adj usted
Gross
Income
Rental real estate, royalties, partnerships, S corporations, trusts, etc. Attach Schedule E
Farm income or (foss). Attach Schedule F
Social security benefits 120a b Taxable amount
Other income, List type and amount See Line 21 Statement
22
Combine the amounts in the far right column for lines 7 through 21. This is your total income tie
23 Educator expenses
23
24 Certain business expenses of reserests, performing artists, and
fee-basis government officials. Attach Form 2106 or 2106-EZ
25
Health savings account deduction. Attach Form 8889
27 Deductible part of self-employment tax. Attach Schedule SE
28 Self-employed SEP, SIMPLE, and qualified plans .
29 Self-employed health insurance deduction
30 Penalty on early withdrawal of savings .
31a Alimony paid le Recipient's SSN ~~
32 RA deduction
3.3 Student !can interest deduction
34
Tuition and fees. Attach Form 8917
35
Domestic production activities deduction. Attach Form 8903
Exemptions
If more than four
dependents, see
rstructions and
check here lie 0
Income
Attach Form(s)
N-2 here. Also
attach Forms
W-20 and
1099-R if tax
was withheld.
If you did not
yet a W-2,
see instructions.
b Taxable amount . .
b Taxable amount .
15b
18b
17
10
11
12
13
14
. 29
30
31a
32
33
34
25
24
26
27
28
35
36
37
Subtract line 36 from line 22. This is your adjusted gross income II" 37
REV 02/25114 rro
Ferm 013)
For Disclosure, Privacy Act, and
Paperwork Reduction Act Notice, see separate instructions. Ebeak
EXHIBIT E
Intuit NHI20212 12121/06
FORM
NEW HAMPSHIRE DEPARTMENT OF REVENUE ADMINISTRATION
DP-10 -2D INTEREST AND DIVIDENDS TAX RETURN
041
For the CALENDAR year 2006or other taxable period beginning and ending
Due Cate for CALENDAR year is on or before April 17,2007 or the 15th day of the 4th month after the close of the taxable eerier'.
STEP 1
Please
Print or
Type
LAST NAME OF ADIVIDUAL OR PROPRIETOR
iiAVENSTEIN, Sr.
FIRST NAME AND INITIAL
l r;OCIAL SECURITY NUMBER
_

Walter P
LAST NAME
HAI NSTEIN
FAST NAME AND INITIAL 1 SPOUSE'S SOCIAL SECURITY NUMBER
Judith P
NAME OF PARTNERSHIP OR FIDUCIARY
FEIN OR DIN
(UMBER AND STREET ADDRESS
112 DeWitt Drive
III

I I. Pr ' i
auunEss (continued)
CITYTTCWN STATE ZIP CODE
Alton NH 0 3809
STEP 2 . 2
..
Entity Type
and Special
Return Type
r,,,DiviouAL
1-
(3) PAN TNERSHIP
X (I) JOINT (4) FIDUCIARY
ut NH Owiluiship Int
TAX FORMS MAILING ADDRESS, CITY/TOVVN,
STATE AND ZIP CODE:
_
Mo Day Year
Initial Return Established NH Residency
Final Return Abandoned NH Residency
Final Deceased SSN
Amended Return: DO NOT use this form to report IRS adjustment
STEP 3
COMPLETE THE SECOND PAGE OF THIS RETURN BEFORE PROCEEDING TO STEP 4
STEP 4
Figure Your
Tax, Credits,
Interest and
Penalties
10 Net Taxable Income (from Line 9)
11New Hampshire interest and Dividends Tax
(Line 10, if positive, multiplied by 5%)
12 Payments:
a Tax paid with Application for Extension
h Payments from current tax period Estimated Tax
c Credit carryover from prior tax period
d Paid with original return (Amended returns only)
13 Tax Due (Line 11 minus Line 12)
14 Additions to Tax:
a Interest
b Failure to Pay
c Failure to File
d Underpa ment of Estimated Tax
14d
10
11
12 a
12b
12c
12d 12
13
14a
14b
14c
14
STEP 5
Figure Your
Net Balance
Due or
Overpayment
15a Subtotal Due (Line 13 plus Line 14)
b Return Payment Made Electronically
15 Net Balance Due [Line 15(a) minus Line 15(b)j (Make
Check Payable to State of New Hampshire)
16 OVERPAYMENT
(If Line 15 is less than zero, enter on Line 16) .. _
17 Amount of Line 16 to be applied to:
a Next year's tax liability
bRefund Please allow 12 weeks for processing
15a
15b
PAY THIS AMOUNT
15
MI
16
DO NOT PAY '''
17 a
17 b
i
Urtier ' ,;Enalt0maf per-tory, I declare that I have examined his return and hi the best of my belief it is true, correct arid complete. If prepared by a person
other than the taxpayer, his declaration is based an all information of which the preparer has knowledge
POA: By checking this hoe and signing below, you authorize us to discuss this return with the preparer listed below.
Self Prepared
Date Saratute of Paid Preparer Othar Than Taxpayer Date
FOR DRA USE ONLY
Preparers Tax Identdication Number
Preparers Address
C.ty/Tcwn Stale Zari Code
013.10
Rev 1011/06
Signature (in lie) AND TITLE, IF FIDUCIARY
It joint return. 30TH ;lames must sign, oven d nnly Dale
cne had ,ncome
NH DEPT OF REVENUE ADMINISTRATION
MAIL DOCUMENT PROCESSING DIVISION
TO: P.O. BOX 2072 or 20: PO Box 1201
CONCORD NH 03302
DP-101
INTEREST AND DIVIDENDS TAX RETURN

041
For the CALENDAR year 2007 or other taxable period beginning and ending FOR DRA USE ONLY
Due Date fo CALENDAR year is on or before April 15, 2008 or the 15th day of the 4th month after the close of the taxable period.
Print
Type
1111
m
STEP 1
or
Check
box if
there
has
been a
name
change
since
last
filing
LAST NAME, FIR,ST NAME & INMAL , .-7
f /ili,."P / -i- / -I'
/'' 1 / Ati-77 I
LAST NA ME Fl GT NAME g INMAL i ,_,4, v ,;L:. -.Aii.. ." ..?,.... .1 iti
11
-;)
\h.-0 , 7 ' 44 r
BER
NAME OF FAB TNERSHiP OR FlOUC [ARV FEIN OR DIN
NUMBER & STREET ADDRESS
1;CRESS (Canuecl, A ffi
1 1 2 '; 'E = 1 dr ri- 1
CMY/TCWN, STATE & ZIP CODE
, ,iCii iv' d v '3' 6(
D ay
STEP 2
Entity Type &
Special
Return Type
INDIVIDUAL PARTNERSHIP 1
I, of NEW
"ear
!II , y0
RE
i"-;
.,_2) JOINT
'4 FIDUCIARY J
HAmP t- ap h i - Final Return Abandoned NH Residency
Interest
0 TAX F OR M S MAILING ADDRESS. crrwrOWN, STATE & ZIP CODE:
Final Deceased
II SSN
Amended Return: 00 NOT use this form to report IRS adjustment.
STEP 3 COMPLETE THE SECOND PAGE OF THIS RETURN BEFORE PROCEEDING TO STEP 4
STEP 4
Figure Your
Tax,
Credits,
Interest
and
Penalties
10 Net Taxable Income (from Line 9) to
11New Hampshire interest and Dividends Tax
12 Payments:
(a) Tax paid with Application for Extension 12(a)
tt
-
(b) Payments from current tax period Estimated Tax 12(01
(b) Credit carryover From prior tax period
12(t1
Pald with original return (Amended returns only) ..
III
(d) 12(d)
...
(a) Interest 14(e)
7.9.r.
(b) Failure to Pay t4(b)
( c) Failure to File
1401
(d) Underpayment of Estimated Tax 4(d) PI
STEP 5
Figure
Your Net
Balance
Due or
Over a p y
meet
(Line 13 plus Line 14)
15 (a) Subtotal Due
.4"4;:.
15(e)
(b) Return Payment Made Electronically
5

15 Net Balance Due [Line 15(a) minus Line 15(b))
(Make Check Payable to State of New Hampshire)._ 1
16OVERPAYMENT
Of Line 15 is less than zero, enter on Line 16) I 18
x
"
:....
(a) Next years tax liability 17f,)
(h) Refund -
Please allow 12 weeks for processing 17(5
)
FOR DRA USE ONLY
Under penalties of perjury, I declare that I have examined this return and to the best of my belief it is true, correct and temple e. (If
prepayby a person other than the taxpayer, !his declaration is based on 311 Information of which the preparer has knowledge.)
P . By,c p n this box
'going below, you authorize us to discuss this return with the preparer listed below.
54/ 1.7/
lu In ink Fdirciary Date P,"eparer's ias identrkation Number Preperer's Teiephole Number
if joint reiurn, BOTH pay Si sign, even if or-tpne had inporne Cale
1:i :lit k,t'72.
Signature fe ink) and Printed Name &Raid Prepener
Print Signatory Name
Paparer's Address
MAIL
NH DRA
TO:
PO BOX 2072
CONCORD NH 03302-2072
Taxpayer's reiephone Number
Gliyacvatt, Sale & Zip Code
OP-10
R e+ 29,21707
3
FORM
NEW HAMPSHIRE DEPARTMENT OF REVENUE ADMINISTRATION
1 DP-10 -2D
INTEREST AND DIVIDENDS TAX RETURN
041
For the CALENDAR year 2008 or other taxable period beginning and ending
Due
Date for CALENDAR year is on or before April 15,2009 or the 15th day of the 4th month after the close of the taxable period.
FOR ORA USE ONLY

STEP 1
Print or
Type
Check
LAST NAME
Havenstein, Sr.
SPOUSECU PARTNERS LAST NAME
Havenstein

FIRST NAME AND INITIAL
Walter P

FIRST NAME ANO INITIAL
Judith P
SOCIAL SECURITY NUMBER

L_J r,,,, 3
'''''''
it
there
has
NAME OF PARTNERSHIP, TRUST, ESTATE, DR LLC
FEDERAL IDENTIFICATION NUMBER OR DEPARTMENT IDENTIFICATION NUMBER
been
a
name
NUMBER AND STREET ADDRESS
112 DeWitt Drive
111 re' " '
IL
. i .:4 ' 111
:KA, ri.
R. _. .. :
change
since
last
ADDRESS (Continued)
filing
CmY('OWN STATE ZIP CODE
Alton NH 03 8 0 9
(1) INDIVIDUAL (3) PARTNERSHIP %
STEP 2
X Entity Type . I) JOINT (4) FIDUCIARY _
of NH Ownership Int
& Special
Return Fyne
TAX FORMS MAILING ADDRESS, CITY/TOWN,
STATE AND ZIP CODE:
Ma Day Year
Final Return Abandoned NH Residency
Final Deceased SSN
X Amended Return: DO NOT use this form to report IRS adjustment
STEP 3
COMPLETE THE SECOND PAGE OF THIS RETURN BEFORE PROCEEDING TO STEP 4
STEP 4
Figure Your
Tax, Credits,
interest and
Penalties
10 Net Taxable Income (from Line 9)
11 New Hampshire Interest and Dividends Tax
12 Payments:
a Tax paid with Application for Extension
b Payments from current tax period Estimated Tax
d Paid with original return (Amended returns only) ..
a Interest .
b Failure to Pay
c Failure to File
d Underpayment of Estimated Tax .
14 a
10
11

12 a
12b
12 c
12d
1.111 12
13
14b
14c
14d 14
MUMM
STEP 5
Figure Your
Net Balance
Due or
Overpayment
15 Net Balance Due [Line 15(a) minus Line 15(b)] (Make
Check Pa to State of New Hampshire ....... ..... able )
16 OVERPAYMENT
(If Line 15 is 'ess than zero, enter on Line 16)
T7 Amount of Line 15 to be applied to:
a Credit - Next Year's Tax Liability
b Refund
15a
15b
PAY THIS AMOUNT -0-
15
16
1
DO NOT PAY -*
17 a
17b
FOR DRA USE ONLY

Under peraitieS of penury, I declare that I have examines this return and to the hest of my helef it is true, correct and complete. (If prepared by a person
other than the taxpayer, this declaration is based on all information of which the preparer has knowledge.)
POA: 3y checking this box and signing below, you authorize us to discuss this return with the preparer listed below.
X

Signature (in ink)
Date
FIaparer's Tax Identification Number Preparers Telephone Number

Self Prepared

S gnature on ink) of Pad Prepare, Date
If foint iettan, BOTH parties must sign, even if only
one had income
Filing as surviving spouse/CU Partner

Cate

Printed Name of Preparer
Print Signatory Name and rite if Fiduciary Pieparer's Address

MAIL NH DRA
TO:
O. BOX 2072 or 2D: PO Box 120

CONCCRD NH 03302

Taxpayer's Telephone No.

Cityrtown State Zip Code

Intuit

NHIZ0212 0103/09

DP-10
An 08/2008
to io Coda
CONCORD NH 03302
:Mae P-10-20
Rev 092009
NHIZ0212 S3122110
FORM NEW HAMPSHIRE DEPARTMENT OF REVENUE ADMINISTRATION
DP-10-2D INTEREST AND DIVIDENDS TAX RETURN
041
For the CALENDAR year 2009 or other taxable period beginning and ending
Due Date lot CALENDAR year is anor before April 15. 2010 or the 15th day of the1th month alter the close of the taxable period.
Print
ll
STEP
Type
1
or
Ch eck
box
if
th ere
h as
been a
name
ch ang e
since
last
filing
LIST NAME
, HAVENSTEIN, SR
FIRST NAME AND INITIAL IA SECURITY NUMBER
WALTER P
SPOUSFJCU PARTNER'S LAST NAME
HAVENSTEIN
FIRST NAME AND INITIAL. SOCIAL SECURITY NUMBER
JUDITH P
IIIIIIIIIIMIt,_
NAME OF PARTNERSHIP, TRUST, ESTATE, CR LIG FEDERAL IDENTIFICATION NUMBER OR DEPARTMENT IDENTIFICATION NUMBER
NUMBER AND STREET ADDRESS
112 DeWitt Drive
gil ...:II'
I ADDRESS (COntinufsn
CITY:TOWN STATE ZIP CODE
Alton NH 0 3 8 0 9
STEP 2
Who is
Taxable
ENTITY TYPE CHECK
(i) INDIVIDUAL
(3) PARTNERSHIP
ONE:
ri ( 1) JOINT
III (4) FIDUCIARY
%of NEW HAMPSHIRE Ownership Interest in Fiduciary or Trust
Ma Day Yew
Initial Return . Established NH Residency
TAX FORMS MAILING ADDRESS, CITY/TOWN, STATE AND ZIP CODE:
*
Final Return . . . . Abandoned NH Residency
Final Deceased . . SSN

Amended Return: DO NOT use this form to report IRS adjustmert.
STEP 3 COMPLETE THE SECOND PAGE OF THIS RETURN BEFORE PROCEEDING TO STEP 4
STEP 4
Figure Your
Tax, Credits.
Interest and
Penalties
10 Net Taxable income (from Line 9)
11 New Hampshire Interest and Dividends Tax
(Line 10 multiplied by 5%)
12 Payments:
a Tax paid with Application for Extension ..... . .
b Payments from current tax period Estimated Tax
d Paid with original return (Amended returns only)
a Interest
b Failure to Pay
c Failure to File
d Underpayment of Estimated Tax
10 =Min
11
MIR _
12a
12b
12e
12d 12
13
14a
14 b
14c
14 d 14
EMI
STEP 5
Figure Your
Net Balance
Due or
Overpayment
Net Balance 15 Due (Line 15(a) minus Line 15(b)) (Make
Check Payable to State of New Hampshire)
16 OVERPAYMENT
(if Line 15 is less than zero, enter on Line 16) . .
a Credit - Next Year's Tax Liability
b Refund (Allow 12 weeks for processing)
15a
PAY THIS AMOUNT 6.
15 b
15
18
DO NOT PAY -4"
17a
17b
FOR caa USE ONLY Under penalties al penury, I declare that I have
examined this return and to the best of my belie) it is true, correct and complete. (if prepared by a person
other than the taxpayer, this declaration is based on all Information of which the prepares has knowledge)
7 POA: By checking this has and signing below, you authorize us to discuss this return with the prepare, listed below.
X
S4pature (in irk) Date Prepares Tax Idenaticadoe Number Fraparees Teephane Number
X
Self Prepared
ii oint return, BOTH parses must aqn, rven if r,try
Date
,ignakiro (In ink) of Paid Prewar Date
..ag had ,rrsme
Li
F ling as surviving spouseICU Partner Printed Name of Preparer
Print Signatory Nemo and Title if FrItictarwTrust Preparers Address
MAIL NH DRA
ITO: P.O. 30X 2072 or 2D: PO Box 1201
Tarrieyees Talesman,' No. i,....._ ,..,
FOR ORA USE ONLY
2012
I DP-10
1 1 111 11 11
00DP101211555
~.villJI ..lertr LC
,.;:,,, NewHampshire
ie,...._ ,_ ,
)
4 ',,AcnewDepartment of
.,s.
Revenue Administration
LIMO DYYYY MMODYYYY
For the CALENDAR year 2012 or other taxable period beginning: and ending:
STEP 1 - PRINT OR TYPE
Check box if there has been a name change since last filing.
Social Security Number
Last Name
HAVENS TEIN, SR
First Name
MI
W ALTER
Spouse's Last Name
H AVENS T EIN
3- PARTNERSHIP 4 - FIDUCIARY 1-INDIVIDUAL X1- JOINT
TIAL RETURN
FINAL RETURN
Tax Forms Mailing Address,Cityfrown, State & Zip Code
VIMDDYYYY
MMDDYVYY
Theck Appropriate Box:
x Payment Enclosed Credit Next Year's Tax Liability No Payment Required
Refund Request
Page I of 5
REV 12/14/12 TTP/
INT TTO
1-)P.0
Rev6 12/2015
MAIL TO: NH DRA, PO BOX2072, CONCORD NH 03302-2072
INTEREST ANDDIVIDENDSTAX RETURN
Due Date for CALENDAR
year is on or before
April 15, 2013
or the 15th day of the
4th month after
the close of the
taxable period.
First Name
MI
J UD I TH
Name of Partnership, Trust, Estate, or LLC
Number & Street Address
1 1 2 DEWITT DRIVE
Jdress (cant nuedl
City / Town
AL TON
Federal Employer ID Number or
Department ID Number
1111111111.11111111111
State Zip Code 4 (or Canadian Postal Cade)
N H 0 3 3 0 9
STEP 2 - Return Type and Alternate Address
of NEW HAMPSHIRE Ownership
ENTITY TYPE - neck Coe
Interest in Fiduciary or Trust
Established NH Residency FINAL DECEASED
Abandoned NH Residency
Date of Death
'MENDED RETURN. DO NOT use this form to report IPS adjustment

Havenstein BLC Petition 6/2014

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Havenstein BLC Petition 6/2014

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STATE OF NEW HAMPSHIRE

BALLOT LAW COMMISSION

1. The undersigned is / are the Grantee(s) of real property located at:

7 Wages, salaries, tips, etc. Attach Form(s) W-2

3a Taxable interest. Attach Schedule B it required

b Tax-exempt interest. Do not include on line 8a f 8b1

qualifying ' lived

tail credit did not

Apt no. Phone number

Spouse's signature. It a joint return, both must s.gn :ale

Slate ZIP code

B a Taxable interest. Attach Schedule B if required

b Tax-exempt Interest. Do not include on line 8a I Obi

130 Taxable interest. Attach Schedule B if required

b Tax-exempt interest. Do not Include on line Ba

9a Ordinary dividends. Attach Schedule B if required

b Qualified dividends .......

ea 2 Yourself. If someone cart claim you as a dependent, do not check box Ba

INTEREST AND DIVIDENDS TAX RETURN

FOR ORA USE ONLY

FIaparer's Tax Identification Number Preparers Telephone Number

O. BOX 2072 or 2D: PO Box 120

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