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Form Ta-41 Instructions - Transient Accommodations - Time Share Occupancy Tax Return Page 4

STEP 9 — Sign your tax return. The sole proprietor, a partner or member, corporate officer, or an authorized agent

must sign and date the tax return, state his/her title, and write the date the return is signed.

2,175 00

DUE, ENTER “0” ON LINE 5. THIS RETURN MUST BE FILED.

thru 4 of column C, and enter here)

FOR LATE FILING ONLY

PENALTY

INTEREST

PLEASE ENTER AMOUNT OF

Make check payable to “HAWAII STATE TAX COLLECTOR” in U.S.

YOUR PAYMENT

dollars drawn on any U.S. bank. Write your T.S.O. Registration

2,175 00

(add lines 5, 6a, and 6b )

Number on the check.

— MAILING ADDRESS —

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.

HAWAII DEPARTMENT

OF TAXATION

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

AUTHORIZED AGENT.

P.O. Box 2430

Honolulu, HI 96804-2430

Henry Aloha

President

2/28/09

SIGNATURE

TITLE

DATE

(808) 123-4567

DAYTIME PHONE NUMBER:

SENDING IN THE TAX RETURN AND PAYMENT

Attach a check made payable to “HAWAII STATE TAX COLLECTOR” in U.S. dollars to the tax return. Write “TSO,”

the filing period, and your T.S.O. registration number on the check so that it may be properly credited to your account.

Do not send cash.

Mail both the tax return and check to the Hawaii Department of Taxation at P. O. Box 2430, Honolulu, HI, 96804-2430.

Form Ta-41 Instructions - Transient Accommodations - Time Share Occupancy Tax Return Page 4