Form N-288c - Application For Tentative Refund Of Withholding On Dispositions By Nonresident Persons Of Hawaii Real Property Interests - 2015

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FORM
STATE OF HAWAII—DEPARTMENT OF TAXATION
THIS SPACE FOR DATE RECEIVED STAMP
N-288C
Clear Form
APPLICATION FOR TENTATIVE REFUND OF WITHHOLDING
ON DISPOSITIONS BY NONRESIDENT PERSONS OF HAWAII
(REV. 2014)
REAL PROPERTY INTERESTS
2015
For calendar year
or other tax year beginning 
, 2015
NCF141
and ending 
, 20
(NOTE: References to “married”, “unmarried”, and “spouse” also means “in a civil union”, “not in a civil union”, and “civil union partner”, respectively.)
NOTE: DO NOT file this form unless you have received notification from the Department of Taxation that
we have received your withholding payment.
Name (If joint return, give first names and initials of both)
Last Name
Your Social Security Number
Name (Corporation, Partnership, Trust, or Estate)
Spouse’s Social Security Number
Trade Name/Doing Business As (DBA) Name or C/O
Federal Employer I.D. No.
Address (number and street)
Daytime Phone No.
(
)
City, State, and Postal/ZIP Code (province, postal code, and country)
Check only ONE box:
Description of Hawaii real property transaction:
a. Date of transfer (month, day, year) _________________________________
Individual
b. Location and general description of property
Others (Corporation, Partnership,
Trust, or Estate)
c. Tax map key number _____________________________________________
Was the property used at anytime as a rental? Yes
No
If yes, enter your Hawaii Tax I.D. Number: W __ __ __ __ __ __ __ __ - __ __ and
indicate the start date and end date of the rental activity: (month, day, year) ____________________ to (month, day, year) ____________________
1
1. Enter the amount withheld on Form N-288A. (Attach a copy of Form N-288A) ...............................................................
2
2. Sales price .......................................................................................................................
3
3. Cost or other basis (see Instructions) ..............................................................................
4
4. Gain. Line 2 minus line 3 (see Instructions for installment sales) ....................................
5
5. Enter the tentative tax on the gain (see Instructions) .......................................................................................................
6. REFUND of amount withheld. Line 1 minus line 5. (This line MUST be filled in.) ........................................................
6
I hereby declare under penalties provided by section 231-36, HRS, that I have examined this application and accompanying attachments, and, to the best of my knowledge and
Please
belief, they are true, correct, and complete.
Sign
__________________________________
_________________________
__________________
Signature
Title (If applicable)
Date
Here
__________________________________
_________________________
__________________
Signature
Title (If applicable)
Date
MAILING ADDRESS
HAWAII DEPARTMENT OF TAXATION
P. O. BOX 1530
HONOLULU, HAWAII 96806-1530
FORM N-288C

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