Hawaii Tax Form G45 Page 3

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Column a
Column b
Column c
BUSINESS
VALUES, GROSS PROCEEDS
EXEMPTIONS/DEDUCTIONS
TAXABLE INCOME
ACTIVITIES
OR GROSS INCOME
(Attach Schedule GE)
(Column a minus Column b)
PART I
-
GENERAL EXCISE and USE TAXES @
1/2
OF 1% (.005)
1. Wholesaling
LU
2. Manufacturing
z
LU
3. Producing
0
4. Wholesale Services
LU
5. UseTaxon
Imports For Resale
6. Business Activities of
Disabled Persons
C)
LU
C)
7.
Sum of Part I, Column c (Taxable Income)
—
Enter the result here and on Page 2, line 21, Column (a)
PART II- GENERAL EXCISE and USE TAXES @ 4% (.04)
8. Retailing
9. Services Including
Professional
10. Contracting
11. Theater, Amusement
and Broadcasting
12. Commissions
13. Transient
Accommodations Rentals
14. Other Rentals
15. Interest and
All Others
16. Use Tax on Imports
For Consumption
17. Sum of Part II, Column c (Taxable Income)
—
Enter the result here and on Page 2, line 22, Column (a)
0
DECLARATION
-
I declare, under
the penalties set forth in section 231-36, HRS, that this return (including any accompanying schedules or statements) has been
examined by me and, to the best of my knowledge and belief, is a true, correct, and complete return, made in good faith for the tax period stated, pursuant to the
General Excise and Use Tax Laws, and the rules issued thereunder.
IN THE CASE OF A CORPORATION OR
PARTNERSHIP. THIS RETURN MUST BE SIGNED BY AN OFFICER, PARTNER OR
MEMBER, OR DULY AUTHORIZED AGENTI
D NO 01
I
~c4
Trc~su~
14
~ontinued on Page 2
—
Parts V & VI
MUST
be completed
~rm~j~
16
WEB
FORM G-49
(Rev.
2008)
hUHl h I l ~ Ni l U N 1 1 1 1 1 I U INi l I l l
GCFO81
STATE OF HAWAII
—
DEPARTMENT OF TAXATION
GENERAL EXCISE/USE
ANNUAL RETURN &
RECONCILIATION
DO NOT WRITE IN THIS AREA
TAXYEAR ENDING
06
-
30
-
14
HAWAIITAXI.D.NO.W
32184984
-
01
NAME: HAWAII CAPTIVE INSURANCE COUNC
Last 4 digits of your FEIN or SSN
2660
0
0

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