Form Ta-11 - Periodic Transient Accommodations Tax Return - 2005
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FORM TA-11
STATE OF HAWAII — DEPARTMENT OF TAXATION
22
DO NOT WRITE IN THIS AREA
(REV. 2005)
— AMENDED —
PERIODIC TRANSIENT ACCOMMODATIONS TAX RETURN
NAME: ___________________________________________
£
MONTH OF _________________________ , ______
(Do not combine your income for more than one month, if filing monthly.)
£
QUARTER OF _________________________ , ______
W _ _ _ _ _ _ _ _ - _ _
HAWAII TAX I.D. NO.
(Do not combine your income for more than one quarter, if filing quarterly.)
_ _ _ _
LAST 4 DIGITS OF YOUR FEIN OR SSN
£
SEMIANNUAL PERIOD OF _________________________________ , ______
(Do not combine your income for more than one semiannual period, if filing semiannually.)
DO NOT USE THIS FORM AFTER THE ANNUAL RETURN AND RECONCILIATION HAS BEEN FILED.
GROSS RENTAL OR
EXEMPTIONS/DEDUCTIONS
DISTRICT
TAXABLE PROCEEDS
TAXES
RATE
GROSS RENTAL PROCEEDS
(EXPLAIN ON REVERSE SIDE)
a
b
c
d
1 TAXATION DISTRICT 1
(OAHU)
.0725
1
2 TAXATION DISTRICT 2
(MAUI,MOLOKAI,LANAI)
.0725
2
3 TAXATION DISTRICT 3
(HAWAII)
.0725
3
4 TAXATION DISTRICT 4
(KAUAI)
.0725
4
5 TOTAL TAX DUE (ADD LINES 1 thru 4 of column d, AND ENTER HERE)
5
6 PENALTY
6
7 INTEREST
7
8 TOTAL AMOUNT DUE (ADD LINES 5, 6, and 7; ENTER AMOUNT HERE.)
8
9 TOTAL TAX PAID FOR THE PERIOD
9
9
10 ADDITIONAL ASSESSMENTS PAID FOR THE PERIOD, IF INCLUDED ABOVE
10
10
11
11
11
PENALTIES $ _______________ INTEREST $ _______________ PAID DURING THE PERIOD
12 TOTAL PAYMENTS MADE (ADD LINES 9, 10, AND 11)
12
13 IF LINE 12 IS LARGER THAN LINE 8, ENTER CREDIT TO BE REFUNDED (LINE 12 MINUS LINE 8)
13
14 IF LINE 8 IS LARGER THAN LINE 12, ENTER TAXES DUE (LINE 8 MINUS LINE 12)
14
15a
15a
Penalty
15b
Interest
15b
16 TOTAL TAXES NOW DUE AND PAYABLE (ADD LINES 14, 15a AND 15b)
16
17 PLEASE ENTER AMOUNT OF YOUR PAYMENT. Attach your check or money order payable to
“HAWAII STATE TAX COLLECTOR” in U.S. dollars drawn on any U.S. bank AND Form VP-1 to Form TA-11.
Write “TA”, the filing period, your Hawaii Tax I.D. No. on your check or money order.
17
18 GRAND TOTAL EXEMPTIONS/DEDUCTIONS FROM BACK OF FORM
18
I declare, under the penalties set forth in section 231-36, HRS, that this is a true and correct return, prepared in accordance
with the provisions of the Transient Accommodations Tax Law, Chapter 237D, HRS 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 AGENT.
TITLE
SIGNATURE
DATE
––MAILING ADDRESS––
HAWAII DEPARTMENT OF TAXATION
P.O. BOX 2430
HONOLULU, HI 96804-2430
22
FORM TA-11
THIS SPACE FOR DATE RECEIVED STAMP
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