Hawaii Tax Form G45 Page 4

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FORMG-49
Page2of2
FILL
~ hUHI I I I ~
Ni l NH
IhU
h~I
Nh Ih
GCFOS2
21.
Enter the amount from Part I, line 7
$____________________________
22.
Entertheamountfrom Part II, line 17
$
-
23.
Enter the amount from Part Ill line 18, Column c
$____________________________
24.
Enter the amount from Part IV, line 19, Column c
$____________________________
25.
TOTAL TAXES DUE.
Add column (c) of lines 21 through 24 and enter result here.
If you
did
not have any activity for the period, enter “0.00” here
25.
PENALTY
$___________________
26. Amounts Assessed on Periodic Returns
INTEREST
$______________________
26.
27.
TOTAL AMOUNT.
Add lines 25 and 26
27.
28. TOTAL PAYMENTS MADE LESS ANY REFUNDS RECEIVED FOR THE TAX YEAR
28.
29. CREDIT CLAIMED ON ORIGINAL ANNUAL RETURN.
(ForAmended Return ONLY)
29.
30. NET PAYMENTS MADE. Line 28 minus line 29
30.
31. CREDITTO BE REFUNDED. Line 30 minus line 27
31.
32. ADDITIONAL TAXES DUE. Line 27 minus line 30
32.
33.
FORLATEFILING ONLY
T$__________
33.
34. TOTAL AMOUNT DUE AND PAYABLE (Add lines 32 and 33)
34.
35. PLEASE ENTER THE
AMOUNT OF YOUR PAYMENT.
Attach a check or money order payable
to “HAWAII STATE TAX COLLECTOR” in U.S. dollars to Form G-49. Write “GE”, the filing period, and your Hawaii Tax
ID. No. on your check or money order. Mail to: HAWAII DEPARTMENT OF TAXATION, R 0. BOX 1425,
HONOLULU, HI 96806-1425 or file and pay electronically at
If you are NOT submitting a payment with this return, please enter “0.00” here
35.
36.
GRAND TOTAL OF EXEMPTIONS/DEDUCTIONS CLAIMED.
(Attach
Schedule GE)
If Schedule GE is not attached, exemptions/deductions
claimed will be disallowed
36.
_____
ID NO 01
Name: HAWAII CAPTIVE INSURANCE COTJNC
Hawaii Tax I .D. No. W 32184984
-
01
Tax Year Ending 06
-
30
-
14
Last 4 digits of your FEIN or SSN 2660
Column
b
EXEMPTIONS/DEDUCTIONS
(Attach Schedule GE)
Column c
TAXABLE INCOME
(Column a minus Column b)
Column a
BUSINESS
VALUES, GROSS PROCEEDS
ACTIVITIES
OR GROSS INCOME
PART III
-
INSURANCE COMMISSIONS @ .15% (.0015)
18. Insurance
Commissions
Enter this amount on line 23, Column (a)
PART IV
-
CITY & COUNTY OF HONOLULU SURCHARGE TAX @ ½ OF 1% (.005)
19.
Oahu Surcharge
Enter this amount on line 24, Column (a)
PARTV
—
SCHEDULE OF ASSIGNMENT OFTAXES BY DISTRICT (ALL
taxpayers MUSTcomplete this Part and may
be subject to a 10% penalty for noncompliance.) See Instructions.
DARKEN
the oval of the taxation district in which you
have conducted business. IF you did business in MORE THAN ONE district, darken the oval “MULTI” and attach Form
G-75.
20.
X
Oahu
Maui
Hawaii
Kauai
MULTI
PART VI -TOTAL RETURN AND RECONCILIATION
TAXABLE INCOME
Column (a)
TAX RATE
Column (b(
Ofl~
x .005
Onn
x
.04
nn
x .0015
nfl
x .005
TOTAL TAX
Column )c)
=
Column (a) X Column )b(
0.00
=$
=$
=$
=$
0.00
0.00
0.00
0.00
Form G-49
(Rev. 2008)

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