Form Itps-Coa - Change Of Address Form
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FORM ITPS-COA
03
DO NOT WRITE IN THIS AREA
(REV. 2009)
STATE OF HAWAII
DEPARTMENT OF TAXATION
CHANGE OF ADDRESS FORM
Name
SSN or FEIN
Spouse’s Name
Spouse’s SSN
Contact Phone Number (daytime)
(
)
PLEASE CHANGE MY:
M AILING ADDRESS TO:
BUSINESS ADDRESS (PHYSICAL LOCATION) TO:
c/o or “In care of” (If this is to be deleted, please write “Delete”)
Street (This address cannot be a P.O. Box.)
Street
City, State, Postal/Zip Code
City, State, Postal/Zip Code
Business Phone Number
Residence Phone Number
(
)
(
)
THE CHANGE OF ADDRESS APPLIES TO MY ACCOUNT(S) OR PERMIT AS INDICATED BELOW:
MY NET INCOME ACCOUNT
For Hawaii Tax I.D. No. W __ __ __ __ __ __ __ __ - __ __
For Hawaii Tax I.D. No. W __ __ __ __ __ __ __ __ - __ __
MY GENERAL EXCISE ACCOUNT(S)
For Hawaii Tax I.D. No. W __ __ __ __ __ __ __ __ - __ __
For Hawaii Tax I.D. No. W __ __ __ __ __ __ __ __ - __ __
For Hawaii Tax I.D. No. W __ __ __ __ __ __ __ __ - __ __
MY EMPLOYER’S WITHHOLDING ACCOUNT(S)
For Hawaii Tax I.D. No. W __ __ __ __ __ __ __ __ - __ __
For Hawaii Tax I.D. No. W __ __ __ __ __ __ __ __ - __ __
For Hawaii Tax I.D. No. W __ __ __ __ __ __ __ __ - __ __
MY TRANSIENT ACCOMMODATIONS ACCOUNT(S)
For Hawaii Tax I.D. No. W __ __ __ __ __ __ __ __ - __ __
For Hawaii Tax I.D. No. W __ __ __ __ __ __ __ __ - __ __
MY RENTAL MOTOR VEHICLE AND TOUR VEHICLE
For Hawaii Tax I.D. No. W __ __ __ __ __ __ __ __ - __ __
ACCOUNT(S)
For Hawaii Tax I.D. No. W __ __ __ __ __ __ __ __ - __ __
MY__________________________________ PERMIT
Permit Number ____________
(Enter the type of permit. For example, liquor, liquid
fuel distributor, liquid fuel retail dealer, cigarette &
For Hawaii Tax I.D. No. W __ __ __ __ __ __ __ __ - __ __
tobacco (non-retail), or retail tobacco.)
Signature
Title
Date
Spouse’s Signature
Date
— MAILING ADDRESS —
HAWAII DEPARTMENT OF TAXATION
P.O. BOX 259
03
HONOLULU, HI 96809-0259
FORM ITPS-COA
THIS SPACE FOR DATE RECEIVED STAMP
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