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.

1

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

3

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

4

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 (``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 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

6

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.

7

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

8

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

9

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.

10

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.

11

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

12

VDavid . 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.

13

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 COMM OS 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:

1 or 3 613/2014 10:46 AM

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

2 of 3 613/2014 10:46 AM

Print This Page http://www.mva.matyland.gov/seutil/display_mod.cfm?MODULE---

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.

Driver Licensing Information is also available for new Maryland residents.

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.. 1 lit.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 Income Tax 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 ', b S

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 1 5 a IRA distributions

16a Pensions and annuities b Taxable amount (see instrs) 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 29 Self-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.

Adjusted 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 instructions.) If the qualifying person is a child but not your dependent, enter this child's name here .

2 3

2

7 Income

Attach Form(s) W-2. here. Also attach Forms W-2G and 1099-R if tax was withheld.

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

Checking a box below will not change your tax or refund.

apartment no.

City, town or post office. it you have a foreign address. see

Alton

nstructionS. State ZIP code

NH 0 3 8 0 9 Check here it you, or your spouse if filing jointly, want $3 to go to this fund? (see instructions)

....... You 11 Spouse 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 3 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) First name Last name

if more than four dependents, see instructions.

2 d Total number of exemptions claimed

7 Wages, salaries, tips, etc. Attach Form(s) W-2 8a Taxable interest. Attach Schedule B if required

b Tax-exempt interest. Do not include on line 8a 8b1 9a Ordinary dividends. Attach Schedule B if required

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 12 Business income or (loss). Attach Schedule C or C-EZ

10 11 12

13 Capital 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 16 a Pensions and annuities

13 14

b Taxable amount (see instrs) b Taxable amount (see instrs) 16a 16 b

17 Rental real estate, royalties, partnerships, S corporations, trusts, etc. Attach Schedule E 18 Farm income or (loss). Attach Schedule F

19 Unemployment compensation 20 a Social security benefits 20 a b

Taxable amount (see instrs) 21 Cther 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 31 a Alimony raid b Recipient's SSN

This is your total income 23

Adjusted Gross Income

24 25 26 27 28 29 30 31 a

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 adjusted 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'

q Yes No

Qualifying widow(er) Qualifying wiclow(er)

A Original amount or as

previously adjusted (see instructions)

B Net change amount of increase

or (decrease) explain in Part II

C Correct amount

Tax Lia. bility

Use Part It on page 2 to explain any changes Income and Deductions (see instructions)

1 Adjusted 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

11 Federal 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)

21 Amount 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 n 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

(1) First name

Last name

(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 OMB No. 1545-0074

Your first name

Mi Lost mane

WALTER P FIAVENSTEIN, SR If a joint 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

Spouse's social security number

Yousomcluasitseecnutehrtrur

A number(s) above. A Checking a box below will not charge o your tax a srephindouse.

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 Married filing jointly (even if only one had income) Marled tiling separately. Enter spouses SSN above & lull name here.

4 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 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

Adjusted Gross Income

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

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

12 Business income or (loss). Attach Schedule C or C-EZ 13 Capital gain a (toss). Att Sch D if regd. If not rciqd, ck here 14 Other gains or (losses). Attach Form 4797 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 through 21. 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 . . 28 Self-employed SEP, SIMPLE, and qualified plans

Income

Attach ForM(s) 'N..2 here. Also attach Forma 'N-2G and 1099-R if tax was withheld.

If you chi not get a IN-2, see instructions.

Enclose, but do not attach, any payment. Also, ;Lease use Form 1040-V.

.CI b Taxable amount (see instrs) b Taxable 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

MIN9a 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 37 Subtract 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:

(1) First name Last name

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

14 Other gains or (losses). Attach Form 4797

15a b Taxable amount

23 23 Educator expenses Adjusted 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

26 Moving expenses. Attach Form 3903 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

30 Penalty on early withdrawal of savings 31 a 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 joint return, spouse's first name Mt Last name JUDITH P HAVENSTE IN 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 rig lorntly, want 13 to go to this fund/

2 IX 3

Filing Status

Check only one box.

Single Married filing jointly (even if only one had income) Married filing separately. Enter spouse's SSN above & full Time here ..

4 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 .

5 n Qualifying widow(er) with dependent child

OiMEI No. 1545-0074 Your social security number

Spouse's social security number

Make sure the SSN(s) , above and on line fic

are correct.

Checking a box below will not change your tax or refund.

k" El You q Spouse

(4) 7rf chid let

nrhfien 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 18 Farm income or (loss). Attach Schedule F

19 Unemployment compensation 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

d Total number of exemptions claimed 7 Wages, salaries, tips, etc. Attach Form(s) W-2 8a Taxable interest. Attach Schedule B if required

b Tax-exempt interest. Do not include on line 8a 9a Ordinary dividends. Attach Schedule B if required

b Qualified dividends

15a ;RA distributions ............ 16a Pensions and annuities

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 tax was withheld.

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 q Married 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 q Qualifying widow(er) with dependent child

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 . 26 Moving expenses. Attach Form 3903

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 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

Your social security number

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 change 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.

Adjusted 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 adjusted 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

Adjusted 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 38 Add lines 23 through 35 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

9a Ordinary dividends. Attach Schedule B if required

b Qualified dividends ....... 10 11 12 13 14 15a 16a 17 18

Unemployment compensation 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 `ae-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 omB No 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 Your social security number

(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 ".'1 and 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 q 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 the qualifying person is a child but not your dependent, enter this child's name here.

5 q Qualifying widow(er) with dependent child

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 q

d Total number of exemptions claimed

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. Your social security number

Apt no.

11111111.1 Spouse's social security number

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 q Spew.*

4 0 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. 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 (see erections). .ILTCN NH 0 3 8 0 9

Foreign country ^arra

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

Adjusted Gross Income

Rental real estate, royalties, partnerships, S corporations, trusts, etc. Attach Schedule E Farm income or (foss). Attach Schedule F Unemployment compensation 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 26 Moving expenses. Attach Form 3903 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 36 Add lines 23 through 35

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 2006 or 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 3 809

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) 11 New 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 b Refund Please allow 12 weeks for processing

15a 15b

PAY THIS AMOUNT 15 MI

16

DO NOT PAY ''' 17 a 17 b i

Ur tier ',;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 ffi11 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 Initial Return Established NH Residency !II, y0 RE i"-; .,_2) JOINT '4 FIDUCIARY J HAmP t-aphi - Final Return Abandoned NH Residency

Interest 0 TAX FORMS 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 11 New Hampshire interest and Dividends Tax

(Line 10, if positive, multiplied by 5%) 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) ..

13 Tax Due (Line 11 minus Line 12)

14 Additions to Tax:

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 16 OVERPAYMENT

Of Line 15 is less than zero, enter on Line 16)

I 18 x "

17 Amount of Line 16 to be applied to: :.... (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 oth er 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-t pne 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

Re+ 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 2X 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

Initial Return Established NH Residency 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 (Line 10, if positive, multiplied by 5%) 12 Payments:

a Tax paid with Application for Extension b 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 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

15a Subtotal Due (Line 13 plus Line 14) b Return Payment Made Electronically

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 an or before April 15. 2010 or the 15th day of the1th month alter the close of the taxable period.

Print

ll

STEP Type

1 or

Check box if there has been a name change 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 . .