New Hampshire                   2019 
                          Department of  
                      Revenue Administration          ED-06
                                                                                  FOR DRA USE ONLY
   PRINT OR TYPE                             COMPLAINT FORM
   STEP 1
   COMPLAINANT INFORMATION                                  4.  HOME PHONE NUMBER:
1.  NAME:
                                                            5.
2.  ADDRESS:                                                    WORK PHONE NUMBER:

    ADDRESS (CONTINUED):                                    6.  EMAIL ADDRESS:

3.  CITY/STATE/ZIP:

   STEP 2
   PARTY AGAINST WHOM COMPLAINT IS ALLEGED                  10. TELEPHONE NUMBER:
7.  NAME:

8.  ADDRESS:

    ADDRESS (CONTINUED):

9.  CITY/STATE/ZIP:

    STEP 3
11. CONCISE STATEMENT CONCERNING THE ALLEGED VIOLATION INCLUDING CITATION OF APPLICABLE SECTION OF RSA 77-G AND/OR  
    REV 3200:

12. STATEMENT OF FACTS: Please explain the basis for your complaint. (Use additional sheets if necessary) Attach any and all documentation to 
    support the complaint.

13. NAMES AND PHONE NUMBERS OF WITNESSES:

    STEP 4
    Under penalties of perjury, I declare that I have examined this document and to the best of my belief the information herein is true, 
    correct and complete.

   COMPLAINANT'S SIGNATURE (IN INK)                         DATE

   PRINT SIGNATORY NAME & TITLE
                                             MAIL TO: NH DRA
                                                      EDUCATION TAX CREDIT
                                                      PO BOX 457
   ED-06
   Version 1.2 7/2018                                 CONCORD NH  03302-0457

                  New Hampshire                           2019 
                  Department of  
                  Revenue Administration                  ED-06
                                      COMPLAINT FORM INSTRUCTIONS

     WHO MUST FILE?                                       LINE-BY-LINE INSTRUCTIONS CONTINUED  
     Anyone who alleges a violation                         
     of RSA 77-G and Rev 3200 should file an Education    STEP 2  
     Tax Credit Complaint Form (Form ED-06).                
                                                          LINE 7  
     WHEN TO FILE?                                        Enter the name of the party against whom the 
     Form ED-06 should be sent as soon as a violation of  complaint is alleged.  
     RSA 77-G has occurred or is known to have occurred.    
                                                          LINE 8  
     WHERE TO FILE?                                       Enter the street address of the party against  
     Form ED-06 may be mailed to:                         whom the complaint is alleged.  
                                                            
     NH DRA                                               LINE 9  
     Education Tax Credit                                 Enter the city, state, and zip code of the party 
     PO Box 457                                           against whom the complaint is alleged. 
     Concord, NH 03302-0457                                 
                                                          LINE 10  
     Or may be hand-delivered to the Department of        Enter the telephone number of the party  
     Revenue Administration during business hours         against whom the complaint is alleged. 
     (Monday through Friday, 8:00 a.m. to 4:30 p.m.) at:    
                                                          STEP 3  
     Governor Hugh J. Gallen Office Park South              
     109 Pleasant Street                                  LINE 11  
     Medical and Surgical Building                        Provide a summary statement about the 
     Concord, NH 03301                                    alleged violation including citation of applicable  
                                                          section of RSA 77-G and/or Rev 3200.  
     NEED HELP?                                             
     Call the Department at (603) 230-5920, Monday        LINE 12  
     through Friday, 8:00am to 4:30pm. For more           Provide all the details about the alleged  
     information visit us on the web at: www.revenue.nh.gov.   violation and why you believe the action or inaction 
     Hearing or speech impaired individuals may call TDD  violated RSA 77-G and/or Rev 3200.  
     Access: Relay NH 1-800-735-2964.                       
                                                          LINE 13  
     LINE-BY-LINE INSTRUCTIONS                            If you know of anyone who also witnessed  
                                                          the alleged violation, provide their names and phone  
     STEP 1                                               numbers.
                                                            
     LINE 1                                               STEP 4  
     Enter the complainant's name.                          
                                                          The complaint must be dated and signed in ink by the 
     LINE 2                                               complainant per RSA 77-G:6. In addition, print the  
     Enter the complainant's street address.              name and title of the complainant signing the  
                                                          application.
     LINE 3  
     Enter the complainant's city, state and zip code.  
       
     LINE 4  
     Enter the complainant's home telephone number.  
       
     LINE 5  
     Enter the complainant's work telephone number.  
       
     LINE 6  
     Enter the complainant's email address.
ED-06
Version 1.2 7/2018