Form G-55 - Annual Return & Reconciliation General Excise/use Tax Return

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STATE OF HAWAII — DEPARTMENT OF TAXATION

FORM G-55

DO NOT WRITE IN THIS AREA

— AMENDED —

(REV. 2005)

ANNUAL RETURN & RECONCILIATION

GENERAL EXCISE/USE TAX RETURN

FOR CALENDAR YEAR 20 __ __

OR FISCAL YEAR ENDING ____ / ____ / ____

MO.

DAY

YR.

NAME: __________________________________________

_ _ _ _ _ _ _ _ - _ _

HAWAII TAX I.D. NO.

LAST 4 DIGITS OF YOUR FEIN OR SSN: __ __ __ __

THIS FORM SHOULD BE USED ONLY AFTER THE ORIGINAL RETURN HAS BEEN FILED AND WITHIN THREE YEARS OF THE DUE DATE OR FILING

DATE OF THE ORIGINAL RETURN, WHICHEVER IS LATER.

SCHEDULE A — ACTIVITIES UNDER CHAPTER 237, HRS — GENERAL EXCISE TAX LAW

VALUES, GROSS PROCEEDS

EXEMPTIONS/DEDUCTIONS

TAXABLE INCOME

BUSINESS

RATE

TAXES

OR GROSS INCOME

(EXPLAIN ON REVERSE SIDE)

(Column a minus column b)

.005

WHOLESALING

.005

MANUFACTURING

.005

PRODUCING

.005

WHOLESALE SERVICES

.005

INSURANCE COMMISSIONS

.0015

RETAILING

.04

SERVICES INCL. PROFESSIONAL

.04

CONTRACTING

.04

THEATER AMUSEMENT AND BROADCASTING

INTEREST

.04

COMMISSIONS

.04

TRANSIENT ACCOMMODATIONS RENTALS

OTHER RENTALS

.04

ALL OTHERS

.04

SCHEDULE B — ACTIVITIES UNDER CHAPTER 238, HRS — USE TAX LAW

.005

IMPORTS FOR RESALE AT 4%

.04

IMPORTS FOR CONSUMPTION

TOTAL TAXES

(ENTER THE SUM OF COLUMN d)

NATURE OF BUSINESS

2a.

PENALTY $

2b.

INTEREST $

TOTAL AMOUNT

(ADD LINES 1 AND 2)

TOTAL TAXES PAID WITH YOUR MONTHLY, QUARTERLY, OR SEMIANNUAL, AND ANNUAL RETURNS FOR THE YEAR.

LIST ALL PAYMENTS ON THE REVERSE SIDE OF THIS FORM.

ADDITIONAL ASSESSMENTS PAID FOR THE PERIOD, IF INCLUDED ON LINE 1

PENALTIES $

INTEREST $

PAID DURING THE PERIOD

TOTAL PAYMENTS MADE (ADD LINES 4 — 6)

CREDIT CLAIMED ON ORIGINAL ANNUAL RETURN

NET PAYMENTS MADE (LINE 7 MINUS LINE 8)

IF LINE 9 IS LARGER THAN LINE 3, ENTER CREDIT TO BE REFUNDED (LINE 9 MINUS LINE 3)

10.

IF LINE 3 IS LARGER THAN LINE 9, ENTER TAXES NOW DUE AND PAYABLE (LINE 3 MINUS LINE 9)

11.

12a. PENALTY $

FOR LATE FILING ONLY

12.

12b. INTEREST $

TOTAL AMOUNT NOW DUE AND PAYABLE (ADD LINES 11 AND 12)

13.

PLEASE ENTER AMOUNT OF YOUR PAYMENT. (Attach your check or money order payable to

14.

“HAWAII STATE TAX COLLECTOR” in U.S. dollars drawn on any U.S. bank AND Form VP-1 to Form G-55.

Write “GE”, the filing period, and your Hawaii Tax I.D. No. on your check or money order.)

15.

GRAND TOTAL EXEMPTIONS/DEDUCTIONS FROM BACK OF FORM

15.

DECLARATION: I declare, under the penalties set forth in sections 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. I also reaffirm the statements on my application (as amended).

IN THE CASE OF A CORPORATION OR PARTNERSHIP, THIS RETURN MUST BE SIGNED BY AN OFFICER, PARTNER OR MEMBER, OR DULY AUTHORIZED AGENT.

SIGNATURE

TITLE

DATE

MAILING ADDRESS: HAWAII DEPARTMENT OF TAXATION, P. O. Box 1425, Honolulu, HI 96806-1425

FORM G-55

THIS SPACE FOR DATE RECEIVED STAMP