Fillable Form A-6 - Tax Clearance Application (2006) (Page 2 of 2) in pdf

FORM A-6

APPLICANT’S NAME FROM PAGE 1

(REV. 2006)

CITY, COUNTY, OR STATE GOVERNMENT CONTRACT:

Bid/Entering Into a Contract

Completion/Final Payment

For completion/final payment of contract, please provide the name and telephone number of the contact person at the State or County Agency.

Name:

Telephone Number:

LIQUOR LICENSING:

Initial

Renewal

Transfer-Seller

Transfer-Buyer

Special Event

CONTRACTOR LICENSING:

Initial

Renewal

10. STATE RESIDENCY:

DATE APPLICANT ARRIVED IN HAWAII

11. ACCOUNTING PERIOD:

Calendar year

Fiscal year ending

(MM/DD)

12. TAX EXEMPT ORGANIZATION:

A) Provide the Internal Revenue Code Section that applies to your exemption.

B) Does your organization file federal Form 990-T, Exempt Organization Business Income Tax Return?

YES

13. CORPORATION:

Parent’s Corporation Name

FEIN

14. INDIVIDUAL:

Spouse’s Name

SSN

15. IF YOU DO NOT HAVE A GENERAL EXCISE TAX LICENSE AND REQUIRE A TAX CLEARANCE FOR A GOVERNMENT CONTRACT:

A) Has your firm had any business income in Hawaii prior to the Bid?

YES

B) Does your firm have an office, inventory, property, employees, or other representatives in the State of Hawaii?

YES

C) Has your firm provided any services within the State of Hawaii?

YES

16. FILING THE APPLICATION FOR TAX CLEARANCE:

The completed application may be mailed, faxed, or submitted in person to the Department of Taxation, Taxpayer Services Branch. Applications which re-

quire an Internal Revenue Service Tax Clearance will be forwarded to the Internal Revenue Service after processing is completed by the Department of Taxa-

tion. Allow up to 10 to 15 business days for processing between the Department of Taxation and the Internal Revenue Service.

State Dept. of Taxation

Internal Revenue Service

TAXPAYER SERVICES BRANCH

WAGE & INVESTMENT DIVISION

P.O. BOX 259

-TC M/S H214

HONOLULU, HI 96809-0259

FIELD ASSISTANCE GROUP 562

TELEPHONE NO.: 808-587-4242

300 ALA MOANA BLVD., #50089

TOLL FREE: 1-800-222-3229

HONOLULU, HI 96850

FAX NO.: 808-587-1488

TELEPHONE NO.: 808-539-1555

FAX NO.: 808-539-1573

830 PUNCHBOWL STREET, RM 124

HONOLULU, HI

96813-5094

TAXPAYER ASSISTANCE CENTER

HONOLULU:

300 ALA MOANA BLVD., RM 1-128

Applications are available at Department of Taxation and IRS offices in Hawaii, and may also be requested by calling the Department of Taxation’s Forms By

Fax/Mail request line on Oahu at 808-587-7572 or toll-free at 1-800-222-7572. The Tax Clearance Application, Form A-6, can be downloaded from the De-

partment of Taxation’s website ( ).

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - FOR OFFICE USE ONLY - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

Clerk’s

ITEMS

TYPE OF TAX

TAX RETURNS FILED STATUS

Initials

RECEIVED

INCOME

GENERAL EXCISE/USE/

COUNTY SURCHARGE TAX